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Me and my operation: Doctors stuck a balloon in my throat to save me from deadly heartburn
Chronic heartburn can trigger Barrett’s oesophagus — a condition that affects half a million people in this country. If left untreated, it can lead to cancer. Conventional treatment involves drastic surgery, but Edmond Kelly, 59, a retired City broker from Caterham, Surrey, was one of the first Britons to undergo a much less invasive treatment, as he tells DAVID HURST...
My health was fine until I got heartburn in my 40s. It was a burning sensation across my chest. At night, it caused me to sit up in bed because it hurt so much; laying down made it worse.
My GP explained that it’s caused by digestive acids rising up from the stomach into the gullet, or oesophagus, where it burns. I took Rennie tablets, which helped a bit, and later tried Gaviscon. I used to eat a couple of curries every week and found they triggered it, so I cut down to one every few weeks. I drank less coffee for the same reason.
But one day in 2002, my chest hurt more than ever. This time my GP referred me to a gastroenterologist, who did an endoscopy, where they put a tube with a camera on the end down your throat. This test showed I had Barrett’s oesophagus. I’d never heard of it, but the doctor explained that because the acid had been coming up into my gullet for so many years, it had caused the cells there to change.
He said it was a pre-cancerous condition — and even though he said only one in 100 people with Barrett’s would develop oesophageal cancer, the C-word made me come out in a cold sweat.
I was kept under observation, and had to have an endoscopy every nine months. I was told that if the Barrett’s got worse, I’d need a major operation, where they cut out the diseased part of the oesophagus and reconnect the rest of it to the stomach.
It would be a hospital stay of up to two weeks plus a year to recover. On top of that, there would be risks of complications, such as chest infections, pneumonia, leaks where the stomach is reconnected in the chest, and lung collapse. All this frightened the life out of me.
After two years, an endoscopy showed I had a high level of abnormal cells. My doctors said I’d need to have
I readied myself for it, but in 2007 my specialist said there might be an alternative. He arranged for me to see Dr Laurence Lovat, who was performing a new procedure for Barrett’s.
I saw Dr Lovat privately at the London Clinic and he explained they would put a small balloon into the oesophagus. The balloon has a band of electrodes around it to burn away the abnormal cells.
It sounded so much better than the other operation. There were fewer risks and I was told patients are usually allowed home a couple of hours after the operation and should be fully recovered within a few days, or a fortnight at most. I had the first of two sessions in July 2007 and the next three months later. Under general anaesthetic, each session took 40 minutes.
Both times, there was a burning sensation in the centre of my chest afterwards, but I took painkillers. After ten days, I felt better and could eat normally again.
In 2008, I went back for two more treatments a few months apart. This time they used a smaller device for just 20 minutes.
By last year, my doctors said my Barrett’s was cured. I was elated. I’ve had no more heartburn and doctors have told me Barrett’s shouldn’t come back as long as I take Nexium — a pill that cuts the amount of acid your stomach produces — every day for the rest of my life. I’ll also need regular endoscopies.
But I feel fine and am enjoying retirement.
Dr Laurence Lovat is a consultant gastroenterologist at University College London Hospitals NHS foundation trust. He says:
The oesophagus is a tube that runs between the throat and the stomach. When we swallow, a valve at the bottom opens to allow food to pass through into the stomach.
It then closes to prevent digestive acid coming back into the oesophagus. But many people have an ineffective valve that leads to acid reflux or gastro-oesophageal reflux disease (GORD).
The symptoms include heartburn, regurgitation and chest pains.
There can be a number of causes: hormonal changes and increased pressure on this valve during pregnancy; obesity; a rich diet; or a hiatus hernia.
For most sufferers, symptoms are improved with lifestyle changes, such as eating smaller meals, avoiding caffeine, alcohol, chocolate and spicy foods, and taking medicines such as Rennie or proton pump inhibitors, which cut acid production.
However, one in ten with chronic acid reflux goes on to develop Barrett’s oesophagus. It takes five to ten years to develop.
The cells that line the lower end of the oesophagus are damaged by the digestive acid, and abnormal cells develop.
As Barrett’s oesophagus does not usually cause any symptoms — other than those associated with acid reflux — it’s not picked up until people go to their doctor with symptoms of oesophageal cancer, such as not being able to swallow.
Every year, 7,000 people die of oesophageal cancer — it’s Britain’s fifth-biggest cause of cancer deaths.
The incidence has risen six-fold since the Seventies, perhaps due to diet changes and increased stress. Until recently, the only cure was major surgery, called an oesophagectomy.
It involves cracking open the chest wall and opening the abdomen to take away the bottom half of the oesophagus, moving the stomach up into the chest and reshaping it to make a new swallowing tube for food to go down. But nearly half of patients end up with complications, and there is a long recovery, with two or three months on a liquid diet.
However, a different technique, developed in the U.S. seven years ago, means the abnormal cells can be destroyed without surgery.
This technique — called Halo 360 — uses high-energy radiowaves to burn away the abnormality on the lining of the oesophagus, leaving the outer muscular wall intact so there’s no need to remove it.
The first British patient was treated in 2007, but the procedure was approved by the NHS only last year.
With the patient under light anaesthetic, the oesophagus is expanded by a balloon that is put down the throat using an endoscope.
The 3cm-long balloon has a series of electrode lines around its middle. It is inflated and the electrodes are activated using a switch on a machine attached to the endoscope.
This burns off the top half a millimetre of the lining, without destroying the normal tissue in the deeper layers.
The procedure takes 45 minutes and patients can usually go home two hours afterwards. Some experience a sore throat and chest pain for a few days.
A follow-up endoscopy is carried out two to three months later. If there are still some abnormal cells, the procedure is easily repeated, sometimes with a smaller balloon.
Most people need two or three treatment sessions for a complete cure. In a U.S. study last year, 92 per cent of Halo patients remained cured after five years.
The procedure treats Barrett’s, not acid reflux, so it is important for patients to maintain good acid control with proton pump inhibitor drugs after the operation.
Though serious complications are rare, narrowing of the oesophagus can occur in one in 15 patients, which causes difficulty swallowing. This can usually be treated easily.
Bleeding or perforation of the lining of the stomach or oesophagus happens in one in 5,000 cases.
For the first time, we can save thousands of lives by curing the pre-cancerous changes without using complicated and painful major surgery.
What’s more, we can cure the Barrett’s at the same time.