Successful Ablation of Barrett Esophagus (BE) with Dysplasia Using the Halo360 Ablation System

Abstract

Purpose: Worsening dysplasia in BE is associated with increasing risk of esophageal cancer. Ablation using a circumferential balloon (HALO360) has shown promising results for the treatment of both non-dysplastic BE and BE with dysplasia. We report our experience using HALO360 for ablation of BE with dysplasia. Methods: Patients with either low-grade (LGD) or high-grade dysplasia (HGD) diagnosed after adequate acid suppressive therapy with a PPI and confirmed by two pathologists, without prior ablative therapy were treated with HALO360. Patients underwent repeat ablation at 3 month intervals until all BE was ablated. Lugol's chromoendoscopy with targeted biopsies from endoscopically visible BE and 4-quadrant q 1 cm random biopsies from the ablated segment of original BE were obtained at regular follow-up interval to assessed for dysplasia and residual BE. Adverse events with the procedure were recorded. Results: Fifty patients with dysplasia have been treated; 36 patients (men = 35; mean age = 71; median length of BE = 5cm) had atleast one follow-up endoscopy with biopsy and are presented here. 27/36 had LGD (men = 24; mean age = 69; median length BE = 4cm) and 9/36 had HGD (men = 9; mean age = 74; median length BE = 6cm). LGD: Fifteen/27 (56%) patients had complete ablation with no endoscopic evidence of BE, 10 (37%) patients had non-dysplastic BE and 1 (3.5%) patient had BE indeterminate for dysplasia. One (3.5%) patient developed a 5 mm nodule at 12 months follow-up in an otherwise normal appearing esophagus. The nodule was completely resected with single EMR, found to be HGD with intramucosal cancer (IMC) with subsquamous component, patient now is in complete remission for BE and dysplasia. HGD: Five/9 (56%) patients had complete ablation with no endoscopic evidence of BE, 2 (22%) have persistent HGD, 1 (11%) has non-dysplastic BE, and 1 (11%) has BE indeterminate for dysplasia. One (3%) self-limited gastrointestinal bleed occurred in a patient with HGD on aspirin 325 mg and 1 (3%) symptomatic esophageal stricture developed in a patient with LGD, prior history of a pin-hole stricture, and required single balloon dilation. Conclusions: Circumfrential ablation of BE with dysplasia using HALO360 is safe, effective and has excellent patient tolerance. There has been no evidence of “buried Barrett” post-ablation. A single case of esophgeal nodule with HGD-IMC with subsquamous component was observed and successfuly treated using EMR.