Concord Hospital Offers New Treatment for Pre-cancerous Conditions of the Esophagus

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Published on January 23, 2019

Concord Hospital Offers New Treatment for Pre-cancerous Conditions of the Esophagus

Concord Hospital now offers a safe, effective procedure that can spare patients major surgery to treat pre-cancerous conditions of the esophagus.

Radiofrequency Ablation, or RFA, is an option for treating patients who have developed Barrett’s esophagus with either low-grade or high-grade dysplasia, which carry a cancer risk.

Many people suffer from acid reflux, in which the acidic contents of the stomach move backward into the esophagus, the tube that carries food from the mouth to the stomach. Over a long period, repeated reflux can cause a condition called Barrett’s esophagus, in which the lining of the esophagus changes into a lining similar to that found in the intestine. The condition itself is common and not serious, but it increases the risk of cancer.

Typically, doctors use a small camera on the end of a long, flexible tube – an endoscope – to monitor patients with Barrett’s esophagus every two or three years to make sure the abnormal lining doesn’t progress into pre-cancer – low-grade or high-grade dysplasia.

Prior to the use of RFA for Barrett’s esophagus, low-grade dysplasia prompted more frequent exams, or endoscopies. High-grade dysplasia, and its higher cancer risk, was managed by removal of part of the esophagus.

Gastroenterologist Scott Oosterveen, of GI Associates – Concord Gastroenterology, said with RFA, Concord Hospital can offer patients effective treatment, without surgery, for high-grade dysplasia and an option for treating low-grade cases before they develop into a more serious issue.

“In the past, we would have recommended having the esophagus removed,” he said of high-grade dysplasia. “Now, we have high success rates of curing this pre-cancerous condition.”

In Radiofrequency Ablation, Dr. Oosterveen focuses high energy through an endoscope to burn, or ablate, the abnormal lining inside the esophagus. As the burned tissue heals, it regrows the lining that was there originally.

“It’s very safe and very effective,” Dr. Oosterveen said.

Treatment typically involves several ablation sessions, approximately two months apart.

Rather than a difficult surgery, long recovery, and high complication rate for some patients, RFA is an outpatient procedure that may prompt a burning sensation for several days that can be treated with antacids and other medication. And, instead of performing multiple endoscopies to monitor low-grade dysplasia, RFA, in conjunction with an endoscopy offers treatment.

“The complication rates are very low,” Dr. Oosterveen said. “The success rate generally is about 90 percent to remove the dysplasia and about 70-80 percent to remove the Barrett’s esophagus altogether, so it looks like a new esophagus.”

Dr. Oosterveen performed Concord Hospital’s first RFA in May 2018. The Hospital anticipates performing 20-30 RFA procedures a year. Acid reflux disease can affect anyone, but those at higher risk for Barrett’s esophagus include middle-aged, overweight, white men with a long history of reflux.

Patients with questions about their risk for Barrett’s esophagus should contact their primary care physician.

The National Cancer Institute reports that from 2011-2015, the rate of cancer of the esophagus in Belknap and Merrimack Counties, which include many communities served by Concord Hospital, were second and third highest among New Hampshire’s ten counties.