Reflux disease is a common problem with symptoms that include heartburn, regurgitation, chest pain, nausea and dysphagia. If untreated, complications such as Barrett’s oesophagus can develop.
This is when cells in the lining of the oesophagus appear abnormal and have the potential to turn cancerous.
One way that Barrett’s oesophagus is treated is using a medical procedure called Radiofrequency ablation (RFA).
What is radiofrequency ablation?
RFA is a procedure where a balloon is passed down to the bottom of the oesophagus and electrodes attached to it are used to burn away damaged lining.
How is radiofrequency ablation performed?
RFA is performed under light general anaesthetic. A plastic tube will be placed into a vein in the back of your hand of forearm to administer sedatives.
An endoscope is inserted through the mouth down into the oesophagus and a specially designed radiofrequency balloon catheter, consisting of an inflatable balloon-basket with four electrodes, is passed through the endoscope.
The balloon is then inflated and the electrodes deliver radiofrequency energy to the muscle of the lower oesophageal sphincter and the gastric cardia – where the contents of the oesophagus empty into the stomach.
The electrodes are heated several times for about a minute at a time, which changes the tissues in the oesophagus.
How well does the procedure work?
Studies have found that radiofrequency ablation to be “very effective” at destroying abnormal cells in the oesophagus.
One study found that 77.4 per cent of those treated with radiofrequency ablation had a complete eradication of the abnormal cell growth compared with 2.3 per cent in a ‘sham group’ 12 months after treatment.
What are the risks?
Radiofrequency ablation is considered a very safe and extensively researched procedure, although as with any treatment there are potential risks.
Studies have reported a five per cent risk of the oesophagus narrowing, a one in 100 risk of bleeding, and a one in 100 risk of a tear in the oesophagus. On very rare occasions, the treatment can induce an abnormal heart rhythm.
According to the NHS, while the evidence of the safety of endoscopic radiofrequency ablation for reflux disease “is adequate in the short and medium term”, there is uncertainty about longer‑term outcomes.
Some studies have found a 15 per cent risk of Barrett’s oesophagus returning five years later.
How else is RFA used?
Endoscopic radiofrequency ablation has been used as a treatment for gastro-oesophageal reflux disease (GORD).
In a review of nine studies that included 525 patients, it was found that patients’ heartburn had improved significantly two years after RFA procedure.
Health watchdog NICE, says that while there is evidence that this procedure is safe enough in the short term, its long-term safety is uncertain. It says: “When it comes to how well it works, the procedure does seem to relieve symptoms of acid reflux but it’s not clear exactly how it works.”
Stretta Therapy is an endoscopic radiofrequency ablation technique.