What to Expect after HALO Radiofrequency Ablation Therapy
Introduction This leaflet is designed to provide information for patients, and carers looking after people undergoing HALO Radiofrequency Ablation treatment for Barrett s Oesophagus. It will tell you what to expect after treatment. The Halo system is made and distributed in the UK by Covidien Inc. This device applies heat to the oesophagus to ablate (destroy) the inner lining the Barrett s mucosa. The aim is to completely remove this abnormal lining. New, healthy, lining will grow in the next few weeks after treatment. It often takes a few treatments to completely replace the old, unhealthy lining with a new healthy one. Although it is possible to remove the inner lining in everyone who has Barrett s oesophagus, treatment is usually only offered to people who have a moderate or high risk of developing cancer in the future. Most doctors will therefore only treat people who have proven dysplasia (pre-cancerous changes) in the oesophagus. Different Types of Treatment Various types of HALO device are available and new designs are being developed all the time to make the treatment simpler and faster to perform. A) HALO-360 Device The HALO-360 device is a balloon, which applies treatment all the way round the circumference of the oesophagus over a length of 3cm. More than one area can be treated in a single session as each treatment takes only a few seconds to apply. This device is usually applied during the first one or two treatment sessions.
Before HALO-360 treatment Preparing for HALO-360 treatment During HALO-360 treatment After HALO-360 treatment
B) Focal HALO Devices A number of smaller devices can be used to re-treat small remaining areas of Barrett s oesophagus. These include the HALO-90, HALO-60 and HALO-90 Ultra. Other configurations are being developed as well. Many small areas such as tongues or islands of Barrett s oesophagus can be treated during a single treatment session. C) Endoscopic mucosal resection (EMR) Occasionally, when the doctor looks inside, a new nodule or swelling has developed. These are often best removed by a different technique called endoscopic mucosal resection (EMR). The nodule is sucked into a cap on the end of the endoscope. A small elastic band is then placed around the base of the nodule. Finally, the nodule is cut away with a special snare device, which also heats and seals any blood vessels to minimise the risks of bleeding. D) Oesophageal dilatation Occasionally, the doctor finds that the oesophagus is narrowed before starting the treatment. In this situation, it may be better to dilate (stretch) the oesophagus before starting the HALO or EMR. Alternatively, only a dilatation will be done, and the patient will come back at a later date for the other treatment.
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What happens after the treatment? You should expect to experience the following side effects. They usually last for up to 10 days. Soreness or discomfort in the chest or back Discomfort on eating, particularly hot or solid foods Mild nausea Care after having sedation or anaesthesia: If you go home on the day of treatment, we would advise you not to use public transport, particularly if you will need to stand on the on the train or the bus. YOU MUST have someone to take you home. DO NOT drive yourself. Please have someone to take you home in a car or taxi DO NOT drink alcohol for 24 hours after sedation is given DO NOT drive a car or operate heavy machinery for 24 hours after sedation is given Dysplasia This word is derived from the Greek meaning roughly bad formation. Dysplasia in tissue is when the cells have changed abnormally, and may in some cases lead to cancer. Dysplasia is the earliest form of pre-cancerous change that can be recognized and may be rated as either low grade or high grade, the latter representing a more advanced progression towards cancer.
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What you should do after the treatment: 1. Please only drink liquids for the next 24 hours. After this, eat only a soft diet for the next week, avoiding meat, bread, hot drinks and sharp foods such as citrus or pickles. 2. Examples of soft food include jelly, ice cream, mashed potatoes, porridge, semolina pudding, rice, scrambled eggs, minced fish and minced meat. 3. Please take strong acid suppression medication twice daily and continue this for at least 2 months. You should be taking one of the following medicines: Omeprazole, Lansoprazole, Pantoprazole, Rabeprazole or Esomeprazole. If you are not taking one of these drugs, please tell the doctor looking after you immediately. 4. In addition, you may find benefit from taking an antacid whenever you eat such as Maalox or Mucogel. These can be bought at any chemist shop. 5. If you need painkillers, you can take soluble paracetamol or cocodamol for a few days. 6. If you feel sick, try taking an anti-nausea pill which can be bought at any chemist shop. 7. Do not take aspirin or non-steroidal anti-inflammatory medications for 7 days. 8. If you are taking clopidogrel, warfarin or any other blood thinning medicine, you should have been given specific instructions about whether and when to take these. If not, please contact your doctor for advice.
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What complications can happen after Halo treatment? Minor bleeding can occur in 1 in 50 procedures. This is usually detected by the doctor and stopped while the procedure is happening. Narrowing (stricture) of the oesophagus occurs after about 1 in 15 procedures. Patients may be aware that their swallowing does not return to normal after 2 weeks. If this happens, you should contact your doctor who can arrange for an extra endoscopy treatment to dilate (stretch) the oesophagus. These strictures are usually easy to dilate unless you have had previous radiotherapy to the chest. Major bleeding and perforation (hole in the oesophageal wall) occur very rarely, far less than 1 in 100 procedures. In an Emergency you need to contact your endoscopy unit using the telephone numbers provided by them following the procedure. If you have any problems after the procedure such as significant chest pain excessive difficulty swallowing fever bleeding tarry stools abdominal pain difficulty breathing vomiting Please contact your hospital endoscopy department directly during office hours for advice or the telephone numbers provided in your discharge letter.
Further treatments: You will require a further endoscopy in approximately 2 to 3 months time to check the success of the treatment. Patients usually need a few treatments to completely remove the disease. After successful treatment, all patients need to have regular check up endoscopies for the rest of their lives. Please note: If you need care for a digestive issue from any healthcare personnel in the 6 months following the ablation procedure, please contact the HALO specialist before any treatment is initiated. Our thanks to Professor Laurence Lovat, Consultant Gastroenterologist at UCL Hospital and independent medical advisor to HCUK, the author of this patient information booklet. Raising awareness, changing the future
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