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chrisrob
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Quote chrisrob Replybullet Posted: 18†Mar†2015 at 12:08pm
The alternative to lifetime PPIs is a fundoplication to strengthen the lower oesophageal sphincter.
NICE have produced this Options Grid to help patients discuss this alternative with their doctor.

There are other treatments/devices available but not as good as LNF. One that has gained popularity in the States is LINX which has been around for about 10 years. It has been getting a lot of free publicity as every time a clinic in USA makes this treatment available, it's published as a news story that there's this new treatment to cure acid reflux and always including the (false) claims its manufacturer makes that it's better than LNF because it's reversible and you can burp and vomit afterwards. (Which can all apply to LNF.)
It is a shiny metal 'bracelet' of titanium magnets that is fitted around the oesophagus in an operation similar to LNF - and has associated side effects (mainly dysphagia) lasting a few weeks.
It costs about twice as much as LNF and, whereas it is available on NHS, you'd be hard pressed to find a surgeon who'll do it. It's like paying twice as much for a car that may not go and if not you can pay the salesman to take it back and pay again for a cheaper, more reliable, model.

This recent news article attempted to expose the fraud used to sell the device.
LINX has an 85% satisfaction rating over the 5 years worth of data available. LNF has a 94% satisfaction rating over the 20 years worth of data available.

I am gradually compiling and writing reviews of the various treatments which will become available here soon if you're interested.

However, although anti-reflux surgery and sphincter augmentation devices may remove the need for medication, they will not guarantee there'll be no Barrett's progression and you'll still need regular surveillance scoping every few years.
There is much research on-going attempting to discover those most at risk of progression who need the sureillance.
The Barrett's Oesophagus Surveillance Study (BOSS trial) has been running for a few years attempting to assess the efficacy of scoping on demand with regular surveillance scoping. They've just announced a new trial here - but don't expect early results, it's due to run for another 10 years!
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bluetobits
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Quote bluetobits Replybullet Posted: 18†Mar†2015 at 1:11pm
Thanks Chrisrob

The last time I came on here two years ago (post scope No2)I went away with the impression that 'HALO' was the way forward if things were going downhill. I had also checked the cost of getting it done private as I have medical insurance.

seems like I wasn't reading between the lines and it would appear that 'Halo' is no miracle cure just a 'patch' that requires replacing such that it is added to the number of scopes in life.
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chrisrob
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Quote chrisrob Replybullet Posted: 18†Mar†2015 at 1:14pm
Most people don't have to have HALO repeated. But they do need to continue with PPIs and regular scopes.
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jcombs99
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Quote jcombs99 Replybullet Posted: 18†Mar†2015 at 5:19pm
B
Since you have private ins. go read PaulB posts he did the halo and follow up and has done well and barretts hasn't come back .If you have private ins like I do YOU are in charge of your healthcare not the GOV..PPI's help prevent barretts and size in this case doesn't matter . If you have a good doctor and get scoped every year you should be just find .BUT if you go to 2 to 5 years between scopes who knows .Halo is not or never can be a CURE it just removes everything but cancer and a whole lot better then removing the O with HGD like I HAD ..
    My doctor and I are waiting to see the cancer data from Barretts to cancer with the 5 year scopes .The NHS did this to save Funds I don't care about funds I care about a normal O .

HGD Jeff
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bluetobits
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Quote bluetobits Replybullet Posted: 19†Mar†2015 at 11:58am
Jeff

Fully understand the NHS/NICE standpoint based on financial restraints/probability & statistics.

My gastro man is using NICE guidelines and was talking about non dysplasia patients being scoped every 3 years not 2 as at present NICE guidelines.

I have read recently that the hospital where I go for scopes has been deemed a specialist hospital for the monitoring of barretts.

My insurance does not cover scoping @ £1500 a time and the last time I checked it didn't cover halo either as this had not been approved by 'NICE'at the time will check again now.

Sorry I'm not familiar with your personal experience and where you are at the moment with Barretts.

I have received a very informative response to my condition from an eminent gastroenterologist (Dr Laurence Lovat) which I will share if anyone is interested




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chrisrob
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Quote chrisrob Replybullet Posted: 19†Mar†2015 at 12:21pm
Scoping guidance was reviewed in 2013 and the current advice for non-dysplastic Barrett's may be seen in a handy flowchart by clicking here.
Short segment Barrett's should be scoped every 3-5 years and long segments 2-3 years.

The NICE guidance on RFA was reviewed last year and now includes the options for ablation with LGD as well as HGD which was previously recommended. Click here to read it.
In summary: "Current evidence on the efficacy of endoscopic radiofrequency ablation for Barrett's oesophagus with low‑grade dysplasia is adequate provided that patients are followed up in the long term. There are no major safety concerns. Therefore, this procedure may be used in patients with Barrett's oesophagus with low‑grade dysplasia with normal arrangements for clinical governance, consent and audit or research."
"Current evidence on the efficacy and safety of endoscopic radiofrequency ablation for Barrett's oesophagus with no dysplasia is limited in quality and quantity. Therefore, this procedure should only be used in patients with no dysplasia in the context of research."


I agree, Professor Laurence Lovatt is one of the UKs top gastroenterologists, working at UCLH, and a great advocate of RFA having initiated the UK HALO registry (not to be confused with the UK Barrett's Registry). (He is also the lead surgeon in a London private practice, The London Gastroenterology Centre.
(I'll be seeing him again next month at the Barrett's Symposium in London.)
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Quote bluetobits Replybullet Posted: 01†Apr†2015 at 8:47am
Scope done without sedation now the worrying wait!!!!!!!

Not happy

My Barrett's is 8cm long!!!!!! not sure if this is in 'patches' or the last 8cm is totally covered but that's 3 inches.

Can HALO deal with this?????

Waiting to see specialist to see what the coverage is and if this is different to my last scope two years ago - no information last time other than no dysplasia - not genned up enough then to ask.

Guy doing my scope told me new guidelines regarding biopsies 4 biopsies every 2 cm - 16 biopsies so the scope lasted a little longer than last time so I can only assume it has increased in area (or possibly the criteria for biopsies has been increased)
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Quote chrisrob Replybullet Posted: 01†Apr†2015 at 9:38am
Hi again,

8cm is a long segment (about 1/3rd the length of your oesophagus) but I have heard of longer segments being ablated - one nearly the whole length of his oesophagus at 24 cm!

The size will be recorded using the Prague criteria as explained in this diagram.

Biopsies are taken every 2 cm according to the Seattle protocol as explained here.

It's most likely they won't try to ablate it all in one go and would cover the length in two or three sessions with the Halo360 and then touch up the bits that were missed with the Halo90.

Were you given information on length previously? Has the area increased? If so, why? You've been taking PPIs?

Hopefully no dysplasia.

All the best
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bluetobits
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Quote bluetobits Replybullet Posted: 01†Apr†2015 at 11:47am
Morning Chris

During the scope I heard the numbers 38,36,34,32 the Prague criteria only goes up to 36.

the doctor doing the scope said it looked OK but the biopsies are the key even though it's like looking for a needle in a haystack with regard to detection.

The length was never mentioned to me before so I have no idea if the length has increased and yes I have been taking PPI's points for discussion at next meeting.

What I would like is a testimony from someone whohas had the procedure for HALO - are you awake during the procedure? is it more or less uncomfortable than having a scope without sedation? is it painful afterwards?. Are you unable to eat/drink for a period afterwards.

Being scoped every two years is just long enough to forget how uncomfortable it is without a sedative.

The nurse looking after me said sedation was hit & miss due to the effects being different for each person - not what I wanted to hear as I once had it done under sedation and never felt a thing.
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Quote bluetobits Replybullet Posted: 01†Apr†2015 at 11:50am
Chris

Forgot

Do you know anyone who has gone from no dysplasia to HGD or worse between copes?
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