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New service introduced to help reduce risk of oesophageal cancer

Dr Hasan Haboubi, Consultant Gastroenterologist and Clinical Lead for South Wales Barrett’s RFA Service, and his colleagues

People in Wales can be treated closer to home for treatment that can minimise the risk of oesophageal cancer, thanks to the introduction of the South Wales Barrett’s Radiofrequency Ablation (RFA) Service.

The South Wales Barrett’s RFA service, which started in May 2020 and is housed within Cardiff and Vale University Health Board, has already seen 30 referrals to date; all of which have developed consequences of long term Barrett’s oesophagus.

Barrett’s oesophagus is a condition where the lining of the lower part of the oesophagus changes to a lining similar to the stomach. The cause of the pre-cancerous condition is not known but it is believed that many years of acid reflux from the stomach into the oesophagus causes injury to the lining of the oesophagus, known as oesophagitis. In some people this inflammation may lead to damage of the oesophagus cells and progress through a series of stages to oesophageal cancer.

In normal circumstances the oesophagus heals and returns to normal but sometimes the oesophagus does not heal in the usual way; this is where patients require treatment as part of the RFA service.

“Barrett’s oesophagus is prevalent in approximately 2.5% of the adult population in the UK, with around 60,000 new cases per year. The condition often has no symptoms but Barrett’s oesophagus is sometimes found when a person is examined by means of an endoscopy for symptoms of heartburn or in people undergoing endoscopy for some other reason such as investigating anaemia”, said Dr Hasan Haboubi, Consultant Gastroenterologist and Clinical Lead for South Wales Barrett’s RFA Service.

Patients with Barrett’s oesophagus typically undergo surveillance endoscopy with multiple biopsies every six months to five years. Biopsies can show differing stages of cellular changes which have the potential to become cancerous.

Treatment of such pre-malignant changes, also known as dysplasia, often uses a combination of endoscopic mucosal resection (EMR) and a Radiofrequency Ablation (RFA) therapy which is effective in reducing dysplastic Barrett’s tissue. The treatment is performed under conscious sedation in the endoscopy unit and typically takes 40 minutes to perform. Patients usually need three treatments (approximately every three months) to completely eliminate the dysplastic tissue and therefore decrease the risk of oesophageal cancer. Oesophageal cancer is a serious condition but if changes are caught at an early stage, it can be successfully treated.

“Previously, if a patient in Wales needed treatment, they would have to travel to Gloucester Hospital NHS Foundation Trust. By having this service closer to home, it’s more convenient and cost-efficient for our patients as well as allowing all aspects of patient care to be catered for at the highest possible level, from diagnosis and treatment to aftercare. I’m so pleased to have this service at the Health Board and must thank all of the partners and my colleagues in this venture”, added Dr Haboubi.

It is estimated that approximately 58 patients will be treated though the South Wales Barrett’s RFA Service at University Hospital Llandough this year as the estimated 17 patients in North Wales will continue to be referred to the service in Liverpool. The service covers six of the seven Health Boards (Betsi Cadwaladr Health Board is the one that isn’t covered), offering treatment to a population of 2,453,320 people.

The Minister for Health and Social Services, Vaughan Gething, said: “I am delighted to see this service will now be available in Wales. A lot of people have worked hard over a number of years to set up a sustainable service for south Wales and I am grateful to them for their efforts. Patients will certainly benefit from having this treatment closer to home.”