HALO: Technology Evolved

A new procedure provides a sneak attack against a pre-cancerous condition 

Patients with gastroesophageal reflux disease, or GERD, may not only have to deal with the condition's symptoms of heartburn and chest pain, but also its potential to create what is known as Barrett's esophagus. This non-symptomatic condition, which affects about three million Americans, occurs when the lining of the esophagus changes due to the damage done by GERD.

"The normal esophageal lining has a distinct appearance and color," says gastroenterologist Joseph M. Hathaway, MD. "The development of Barrett's esophagus is usually really easy to see when you do an endoscopy."

In an endoscopy, the patient is sedated and an endoscope, or camera, is passed through the mouth into the esophagus. The physician can then take a number of biopsies to determine the level of the condition. The three levels of Barrett's esophagus are intestinal metaplasia, or IM without dysplasia, IM with low-grade dysplasia, and IM with high-grade dysplasia. Dysplasia is an abnormality within the tissue. It is not cancer but it may raise the patient's risk of developing cancer.

"In the past, if someone with Barrett's esophagus developed high-grade dysplasia, we would send them to get their esophagus removed," Dr. Hathaway says.

Now Dr. Hathaway offers a process to treat the condition of Barrett's esophagus before it can develop into something more severe. Surprisingly, the procedure to get rid of Barrett's esophagus is not that much different from the one used to diagnose it. Dr. Hathaway uses a technology called the HALO Ablation Catheter in conjunction with an endoscopy. There are two versions of these catheters; Dr. Hathaway chooses which one to use based on the size and circumference of the segment of Barrett's esophagus. Once inside the esophagus, the catheters ablate, or heat, the diseased tissue until it is no longer alive.

"The remarkable thing about the HALO catheter is that it burns down far enough to get rid of the Barrett's esophagus, but not too far where you might develop a complication such as a perforation or a stricture afterwards," Dr. Hathaway says.

Dr. Hathaway relates this non-surgical procedure to the removal of colon polyps during a colonoscopy, which is a fairly common preventative measure for reducing the risk of colon cancer. Private First Class Scott Clark, a soldier at Fort Stewart, agrees with Dr. Hathaway. He is currently in treatment, which can take from two to five ablations to complete depending on the size of the patient's segment.

"I talked it over with my family," Clark says, "and I decided that the possibility of it turning into something worse, like cancer, was not worth the risk."

Despite the chest discomfort that occurs for a few days after the procedure, Clark is enjoying more peace of mind knowing that Barrett's esophagus will not be a factor in his life-long battle with GERD.

"It's been good," Clark says. "Just a couple of more times and I should be good to go."

"Most people are pretty excited about it," says Dr. Hathaway. "Especially those who have a family member who suffered from esophageal cancer."

Dr. Hathaway notes that of the approximately three million Americans that have Barrett's esophagus, most won't get cancer. However, patients with this condition are 40-130 times more likely to develop cancer when compared to the general population.

"The decision to have the ablation procedure depends on the patient and their thoughts about it," Dr. Hathaway says. "Of course we have to consider age and whether or not the patient is suffering from other diseases to make sure he or she is a good candidate for this procedure."

Dr. Hathaway is still excited by how safe and effective the ablation procedure is for getting rid of Bartlett's esophagus and its potential to become something more.

"When people do get esophageal cancer, the five-year survival rate is only about 16 percent," Dr. Hathaway says. "If this is something we can prevent, that's a great thing."