KINGSPORT– For years, Willie Ogden's selections at the dinner table were limited because of problems with his esophagus.
But a new procedure that has been performed by Dr. Jerry London at Holston Valley Medical Center has allowed Ogden to enjoy cucumbers, onions, pickles and tomatoes without discomfort afterward.
In addition to improving Ogden's meals, the procedure has an important medical benefit – it reduces the risk of esophageal cancer.
Ogden, a 79-year-old Rogersville resident who underwent the procedure a year ago, has experienced a better quality of life since. Called radiofrequency ablation, the procedure treats Barrett's esophagus, a condition that originates from acid reflux and can turn to cancer.
"I had a lot of indigestion and heartburn, and this procedure has corrected those problems," Ogden said. "I've had a wonderful year without heartburn or having to take medicine to treat it. I don't have to take any heartburn medicine at all now."
Having battled Barrett's for 20 years and experienced problems with his esophagus for 50 years, Ogden relishes in the notion that he can now eat a deluxe sandwich and not suffer the consequences.
In radiofrequency ablation, physicians burn the Barrett's from the wall of the esophagus. Dr. London said the procedure produces little pain and discomfort and, most importantly, virtually no recurrence of the cell abnormality.
"The most recent study that has been published followed patients for five years after the procedure and the recurrence rate is very, very low," said Dr. London, who is board-certified in gastroenterology and internal medicine. "One percent got Barrett's back in five years."
About a 30-minute procedure, radiofrequency ablation is performed under moderate sedation, similar to what is used in an endoscopy or a colonoscopy.
"I think it is very effective and it is better tolerated by patients than what I had heard when I was researching this procedure," Dr. London said. "Our patients are tolerating this procedure extremely well. They have had minimum pain and minimum discomfort."
Dr. London said the recovery time from the ablation procedure is quick.
"Usually, within a week, the patient is back to normal," he said. "If they receive treatment on a longer segment, perhaps 2 inches or 2 ½ inches, they might have some heartburn or chest pain for a couple of days and are on a liquid diet for two days. Otherwise, they are back to their normal life."
Compare this treatment to the former method, and one will see some obvious benefits.
Dr. London said patients used to have an endoscopy every two years, followed by a biopsy because of the risk for cancer. If a physician discovered the patient had dysplasia or atypia, where the cells become more disorganized, then that portion of the esophagus had to be removed surgically.
"It's a major surgery to recover from," Dr. London said. "You are never the same again because it is such a major operation."
The esophagus is a muscular tube that carries food from the throat to the stomach. A ring of muscles at the lower end is supposed to keep the food and acid from refluxing into the esophagus. But if these muscles do not close tightly, stomach acid can leak back into the esophagus. This is gastroesophageal (acid) reflux disease, which has symptoms such as heartburn, trouble sleeping and intolerance to various foods.
Sometimes, the acid can damage the lining of the esophagus, creating Barrett's esophagus. Dr. London said one in 200-400 patients with Barrett's will develop esophageal cancer.
"The big problem in the United States is that the incidence of esophageal cancer from Barrett's is going up quickly," Dr. London said. "It has risen 400 percent in the last 20 years. So it is time we start trying to do something."
Dr. London said patients whose Barrett's has dysplasia or atypia are the most likely candidates to undergo the procedure.
"Right now, people that you would select for the procedure have Barrett's with these changes or somebody who is young and is going to have Barrett's for 30 or 40 years," Dr. London said. "Clearly, if someone appears to be at risk for esophageal cancer, you want to treat him or her with radiofrequency ablation."
Dr. London said radiofrequency ablation has been available in the United States for about six years. He said he reviewed studies on the procedure until he became convinced it was effective. He then went to the University of North Carolina Medical Center to learn the technique under the tutelage of Dr. Nick Shaheen.
Dr. Jerry London demonstrates a radiofrequency ablation procedure in the gastrointestinal lab at Holston Valley Medical Center.
