Endoscopic ablation of Barrett's esophagus using the HALO system

There is increasing interest in endoscopic treatment for Barrett's esophagus because it is the primary risk factor for adenocarcinoma of the esophagus, and the incidence is increasing. Of the various endoscopic treatments available, radiofrequency ablation is the one that has been studied the most. The principle of radiofrequency technology is to deliver a high power (approx. 300 W) over a short period of time ( < 300 ms) and to utilize energy density control. Recent studies suggest its utility for patients with low-grade dysplasia and high-grade dysplasia. In most instances, patients with intestinal metaplasia only with no dysplasia are followed with endoscopic surveillance rather than endoscopic treatment. Radiofrequency ablation treatment may be delivered by either a balloon device (HALO³⁶⁰; HALO^® system, BSPACERRX, Sunnyvale, Calif., USA) or a paddle device attached to the tip of the endoscopy (HALO⁹⁰). After initial endoscopic treatment a repeat endoscopy is performed in 2-3 months to determine the completeness of the ablation. At the current time, even if there is no residual Barrett's seen at the follow-up examination, surveillance is still advised. This is because the device was first used in 2003 and long-term durability had not been established. It is hoped that when durability has been demonstrated for the removal of both metaplasia and dysplasia, long-term surveillance will not be needed.