Halo 90 and 360

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If you have diabetes, ask your regular doctor for diet and medication restrictions.
If you take a medication to thin your blood (such as Coumadin®, Plavix® or Lovenox®) and have not already discussed this with our office, please call us at 612-871-1145.
If you take Aspirin or NSAIDS, please stop taking them two days prior to your procedure.

Other Medications: The following medications may interact with the sedation used for your procedure. If you take any of these medications please call our office at 612-871-1145: crizotinib (Xalkori), enzalutamide (Xtandi), isocarboxazid (Marplan), linezolid (Zyvox), moclobemide, phenelzine (Nardil), procarbazine (Matulane), rasagiline (Azilect), selegiline (Emsam, Eldepryl, Zelapar), tranylcypromine (Parnate), mifepristone (Korlym, Mifeprex), boceprevir (Victrelis), conivaptan (Vaprisol), efavirenz (Sustiva), ketoconazole, sodium oxybate (Xyrem), telaprevir (Incivek).
If you are or may be pregnant, please discuss the risks and benefits of this procedure with your doctor.
You must arrange for a ride for the day of your exam. If you fail to arrange transportation with a responsible adult, your procedure will need to be cancelled and rescheduled.
If you must cancel or reschedule your appointment, please call 612-871-1145 as soon as possible.

PREPARATION

To ensure a successful exam, please follow all instructions carefully. Failure to accurately and completely prepare for your exam may result in the need for an additional procedure and both procedures will be billed to your insurance.

Before your procedure:

If a health history form is enclosed, please complete the form and bring with you on the day of your appointment.The night before your exam:

The night before your exam:

  • Stop eating solid foods at 11:45pm.
  • Clear liquids are okay to drink (examples: water, Gatorade, clear broth and apple juice).
  • Do not drink red liquids or alcoholic beverages.

The day of your procedure:

  • Stop drinking clear liquids 6 hours before your exam.
  • You may take your usual medications with 4oz. of water at least 2 hours prior to your procedure.

When you leave for the procedure:

  • Bring a list of all your current medications; incluceing any allergy or over-the-counter medications.
  • Bring a photo ID as well as up-to-date insurance information, such as your insurance card and referrral forms that might be required by your insurnace company.

DESCRIPTION OF HALO 90, HALO 360

What is a Halo procedure?

Halo is a procedure that uses radio frequency (RF) energy delivered to a specific area in the esophagus where Barretts esophagus exists. Barrett's Esophagus is a condition in which the esophagus changes so that some of the esophageal lining is replaced by a type of tissue similar to that normally found in the intestine. This change can sometimes lead to cancer of the esophagus.

During the Halo procedure, RF energy will destroy the Barretts cells without destroying the normal tissue in the deeper layers of the esophagus. The esophagus is expanded by a balloon and the RF energy heats the Barrett's cells and destroys them allowing healthy new tissue to grow in place.

What should I expect during the Halo procedure?

Plan to spend up to 2 hours at the endoscopy center. The procedure itself takes about 30 to 60 minutes to complete.

Before the procedure:

  • You will changes into a gown and robe
  • You will be asked about your medical history
  • You will be given a consent form to sign
  • A nurse will insert an intravenous (IV) line into your hand or arms.

During the procedure:

  • You will be given a mild sedative of anesthesia to help you relax
  • Your throat will be sprayed with an anesthetic
  • You will lie on your side on an exam table
  • Your heart rate and oxygen levels will be monitored
  • The doctor will carefully advance a flexible, hollow tube, called an endoscope, through your esophagus to the area of the abnormal Barrett's cells.
  • You may have a feeling of pressure or fullness.
  • The Halo device will be passed through the endoscope to treat the Barrett's cells.
  • Once abnormal cells are eliminated, healthy new tissue will grow in its place.

 

 

What should I expect after the procedure?

  • You will rest for 30 to 60 minutes after the procedure
  • The doctor will talk with you about the results of your Halo procedure before you leave the endoscopy center
  • A nurse will provide you with written discharge instructions to take home with you
  • Your throat may feel sore, and it may be painful to swallow
  • You may experience mild chest pain or nausea for two to three days. This is normal.
  • Medication or anesthesia given during the procedure will prohibit you from driving for the rest of the day
  • Diet instruction will be discussed with you before you leave the endoscopy center. A liquid diet may be recommended for one or two days following therapy.
  • You should avoid sharp-edged foods (such as chips, nuts, popcorn, croutons, etc.) during this period.
  • You may resume your regular activities the day after the procedure.
  • A follow-up endoscopy exam is necessary two to three months after treatment to make certain that all abnormal cells have been eliminated.

 

Are there possible complications from an Halo procedure?

Although serious complications are rare, any medical procedure has the potential for risks. A nurse will review all potential warning signs with you before you leave the endoscopy center. Risks include:

  • Perforation, or a tear, of the lining of the stomach or esophagus
  • Bleeding from the biopsy site, if any tissue was removed
  • Reaction to medications used for the procedure

 

How many treatment sessions will I need an over what time frame?

Most people need two or three Halo treatment sessions to achieve a cure. Some people will need more, some less. Halo treatment sessions are usually performed every two to three months until there is no more visible Barrett's esophagus. Your doctor will then take biopsy samples of your esophagus, similar to previous surveillance endoscopies you may have had to monitor your Barrett's esophagus. This is to confirm that your Barrett's esophagus is gone. Over all, in most people, the Halo treatment course involves 2-3 treament sessions over the time period of 4 months to one year.

 

What are the cure rates:

In the peer-reviewed medical literature, published cure rates of Barrett's esophagus are 77%-100% with radiofrequency ablation (Halo).

 

How often does Barrett's esophagus come back after Halo treatment?

In a recent study evaluating durability of cure in Barrett's esophagus patients who had undergone Halo treatment, 92% of patients remained cured at 5 years. Barrett's esophagus recurred in 8% of the patients. In the patients with recurrent Barrett's esophagus, the recurrent disease was the same grade as the original (baseline) diesase. In other words, there was no disease progression in these patients. It is extremely important to maintain good acid control after Halo treatment. This may be achieved by medications (such as PPIs) or by surgical or endoscopic repair, or a combination of the two. The patients described in the study above continued on acid suppression medication (mostly PPIs) after Halo prevent Barrett's esophagus recurrence.

 

Will I still need to undergo endoscopy (EGD) with biopsy surveillance after undergoing Halo therapy?

Currently, most doctors continue to perform endoscopic biopsy surveillance in patients who have undergone Halo. You should discuss the specific terms of your post-Halo endocopic biopsy surveillance schedule with your doctor.

 

Will I still need to take my acid reflux (PPI) medication after undergoing Halo treatment?

Halo treats Barrett's esophagus, not acid reflux. Therefore, your acid reflux will need to be managed after Halo. You and your doctor will decide on the best management strategy based on your individual needs.

 

Will I still have reflux after undergoing Halo?

Yes. The Halo preocedure does not treat acid reflux. Halo treats Barrett's esophagus, which is a change in the cells that line the esophagus that occurs as a results of chronic acid reflux. So, Halo treats Barrett's esophagus, but not its cause. You and your doctor will determine the best management for your reflux after under going Halo treatment.

 

For more information:
•  http://www.curebarretts.com/
• http://www.asge.org/PatientInfoIndex.aspx?id=8954   -American Society for Gastrointestinal Endoscopy (ASGE)
• http://www.acg.gi.org/patients/gihealth/barretts.asp   -The American College of Gastroenterology (ACG)

Results from any testing will be sent via mail.

Rev 11/25/2013