Print Page | Close Window

When is Barrx recommended?

Printed From: Barrett's Support Forum
Category: Barrett's Support Forum
Forum Name: Barrett's Oesophagus
Forum Discription: Your Questions about Barrett's Oesophagus
URL: http://www.barrettscampaign.org.uk/forum//forum_posts.asp?TID=259
Printed Date: 15áJulá2020 at 7:11am


Topic: When is Barrx recommended?
Posted By: twix38
Subject: When is Barrx recommended?
Date Posted: 29áJulá2009 at 6:31pm
This is a question for Geoffrey Blyth and anyone else with info.

I think I read somewhere that Barrx Radiofrequency was originally developed to treat non dysplastic Barratts, but in any event...I have a 3cm length, non dysplastic and would ordinarily think about undergoing Barrx.

However my consultant who is very familiar with Barrx Radiofrequency tells me that he would not recommend Barrx for non dysplastic Barratts and no professional would or should do it, except possibly on a trial, as there is not yet enough data to recommend it officially for non dysplastic barratts. Better to wait for more data or review if/when dysplaysia progress. I am on daily PPI'S 20mg.

My view, after giving it lots of thought, is that this is probably the sensible route whilst non-dysplastic and allowing more data to be collected on Barrx and follow ups on outcomes and hence best practice for use of Barrx and on what stage of dysplasia is most effective or ill advised etc.

Anyone?




Replies:
Posted By: gblyth
Date Posted: 29áJulá2009 at 7:05pm
Hi There
As I am involved in the distribution of the Halo RFA system from Barrx Medical I cannot really advise you on you particular condition.

Suffice to say that since its introduction to the UK in 2007 there have been about 100 patients treated with RFA. Most of these have been patients with long segments of HGD who are unfit for surgery or have opted for treatment with RFA. One of these patients talks about their experience at Addenbrookes on this weeks Case Notes programme on Radio 4



A few patients have opted for treatment of LGD in private centres. I think only one patient with non-dysplastic Barrett's has opted to have it removed using RFA although this is common in the USA. 37,000 procedures or thereabouts

NICE have not yet approved the treatment outside of a clinical trial but we expect, following the positive results that NICE will approve it for HGD by May 2010

A new Multi Centre clinical trial comparing surveillance versus RFA will be starting soon in a few of the centres offering RFA so one of these trials may be an option for you.

Once these commence I will post news on this site.

Regards
Geoff

http://www.bbc.co.uk/programmes/b00ls6bq#synopsis - Click here to hear Radio 4 Including RFA at 14 mins

-------------
I would like to declare that I am a director of SynMed Limited the company that distributes the Halo Treatment from Barrx Medical in the UK.

Geoffrey Blyth






Posted By: twix38
Date Posted: 29áJulá2009 at 7:21pm
Thanks Geoffrey,

I would indeed be most interested to know when this trial does start.
Though whether I should look to take part or bearing in mind the substance of my post, to rather await the outcome of other participants is a keen judgement call, as it may take years for results to be deemed worthy of conclusive and clinical benefit/proof from this trial, I expect.

I take it my premise was correct from what you have written, in that RFA is indeed not yet recommended procedure when non displastic?

You mention Non dysplastic RFA is done in USA (37,000). Is this recommended by the FDA for non dyaplastic specifically, over in the States?

Thanks


Posted By: twix38
Date Posted: 29áJulá2009 at 7:25pm
duplicate post


Posted By: gblyth
Date Posted: 30áJulá2009 at 9:18am
http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1198 - Details of the SURF Trial

The FDA do not specify LGD HGD etc. They only approve the device for sale see link

http://www.accessdata.fda.gov/cdrh_docs/pdf6/K062441.pdf - FDA for Halo 90

I understand Non Dysplastic patients are treated under a registry in the US

Lastly to keep an eye on what is happening with treatments in the US you can read the posts at



Regards

Geoffrey
http://www.barrettsadvice.com/forum/viewforum.php?f=2&sid=6d09fbe8520af7f8e8d12a853e4c586a - US Discussion Board on Barrett's

-------------
I would like to declare that I am a director of SynMed Limited the company that distributes the Halo Treatment from Barrx Medical in the UK.

Geoffrey Blyth






Posted By: twix38
Date Posted: 30áJulá2009 at 10:47am
Thanks Geoffrey,

Looking at the SURF link for surveillance versus RFA.
I mentioned I was non dysplastic, when you referred me to upcoming trials. This SURF is for LGD.

Does that mean there is another trial due for surveillance versus non dysplastic as well, as LGD results would still not apply to me as yet?

It seems to be getting clearer that at the moment RFA is simply not advised for non dysplastic Barratts by the relevant professionals- and that is the core question for me?

Some posters who are non dysplastic are electing to do RFA, in the USA, but I can't find any professional here who recommends to do this yet for non dysplastic. In fact quite the opposite as I've been advised not to.

Hopefully there will be a trial to determine this as i'm keen to be proactive and pre-empt progression where possible and when generally recommended.

Many thanks


Posted By: egoodman
Date Posted: 17áSepá2009 at 7:47am
 I would like to introduce myself to the Forum
 
I am a surgeon based in the USA but working with Professor Mike McMahon of the Nuffield Leeds Hospital
 
We are about to open the first private endoluminal anti-reflux surgery clinic in the UK and are looking for GORD patients interested in the Esophyx TIF procedure
 
This procedure is designed to cure GORD and allow Barrett's oesophagus to resolve
 
It has many advantages over the Barrx procedure since it is based on sound anti-reflux surgical principles
 
For more info, visit http://www.nomorereflux.co.uk/ - www.nomorereflux.co.uk
Feel free to email me any Qs at mailto:egoodman@chpnet.org - egoodman@chpnet.org
 
Dr Elliot R Goodman


Posted By: twix38
Date Posted: 17áSepá2009 at 7:57am
egoodman,

You wrote "...This procedure is designed to cure GORD and allow Barrett's oesophagus to resolve. It has many advantages over the Barrx procedure since it is based on sound anti-reflux surgical principles"

I have a problem with your above summary.....TIF resolves GORD, but Barratt's does not usually heal or resolve itself even if not under acid/bile attack. The Barratt's would/should not get worse with a successfull TIF, but how can you claim that the TIF procedure is resolving the Barratt's directly, which is what Barrx Radiofrequency does or that the Barratt's will resolve just because no further acid attacks takes place?

I don't follow your logic or think you have correctly characterised the issues or treatments and to suggest Barratt's resolves after TIF is highly questionable and it is not generally the case that Barratt's is known to resolve or disappear, though it may?
 


Posted By: egoodman
Date Posted: 17áSepá2009 at 8:23am
Apologies
Probably better to say that the TIF procedure will cure the GORD and can STABILIZE the Barrett's by halting the ongoing exposure of the oesophagus to acid attack
Symptoms will however resolve in >80% of patients
A combination of TIF and Barrx would be an interesting thought


Posted By: twix38
Date Posted: 17áSepá2009 at 8:55am
I also understood that the trial by Chris Fraser did not include any Barratt's data and was not currently being taken on for Barratt's. In fact the supporting sheet stated to exclude barratt's as a rule.

Has this changed and is TIF now supporting Barratt's patients from sourced trials on TIF with patients who had Barratts??

I suffer form GORD and Barratts and I am keen to get both resolved. I expected to do TIF followed by Barrx and was awaiting for TIF to have some data on Barratt's patients who had done TIF, in order to see the success rate in GORD and what happened to their Barratt's afterwards, then Barrx to remove the Barratts.

I must say that your original summary has put me off TIF, as is seemed a little misleading, especially also stating that TIF has many advantages over Barrx when you have rightly corrected that they focus on different issues and are probably complimentary.
TIF for GORD (once more data is in, on Barratt's patients) and Barrx afterwards to remove unresolved Barratt's.

I just don't know if TIF for Barratt's is a step too far for now, as it's new anyway and as far as I know does not yet have data to support Barratt's and Chris Fraser was deliberately excluding Barratt's patients??


Posted By: jcombs99
Date Posted: 17áSepá2009 at 8:05pm
How about barrx first then TIF or a fundo after your sure the barrettes is GONE.You don't want to hide barrettes .

HGD JEFF


Posted By: egoodman
Date Posted: 17áSepá2009 at 8:35pm
Good idea
Are u interested in TIF?


Posted By: jcombs99
Date Posted: 17áSepá2009 at 8:51pm
Nope , my fundo doesn't work but TIF is way to new for me . Fundos been out since 1955 mine didn't work but looking to have it redone .It's 95% the first time and 80% the sceond time and the doctor said there has been thirds .

GOOD LUCK,    HGD JEFF


Posted By: twix38
Date Posted: 18áSepá2009 at 3:05am
jcoombs99/egoodman,

Makes more sense to me to stop the underlying cause first (TIF/FUNDO) then sort out Barratt's with Barrx and make sure no Barratts left. The other way around means after Barratt's removed it still leaves throat under potential attack by acid whilst throat heals and until TIF/FUNDO can be done resulting in a small chance of returning Barratts, even on medication. Any thoughts?

Would have been nice if egoodman had addressed my earlier question below regarding suitability, histology and existing data for TIF, specifically on patients with Barratts, as it's really coming across like you are simply a salesman. My understanding, as I said, was that Barratts patients were specifically excluded in Dr Fraser's trial and notes? This is rather important to address or you will get no takers and ignoring it is saying a lot, so far??  

"I also understood that the trial by Chris Fraser did not include any Barratt's data and was not currently being taken on for Barratt's. In fact the supporting sheet stated to exclude barratt's as a rule. Has this changed and is TIF now supporting Barratt's patients from sourced trials on TIF with patients who had Barratts??"


Posted By: egoodman
Date Posted: 18áSepá2009 at 2:57pm
The experience in the US withTIF is more advanced than in the UK - it has been in clinical practice off trial since 2007. So far, over 1000 cases have been performed in the US.
I cannot comment on the inclusion/exclusion criteria for the St Mark's trial. However, the recommendations of the manufacturer of the Esophyx device in the US is that it can be (and is) performed on Barrett's patients with GORD. With regards to Barrx, the manufacturer of Esophyx is currently in discussions with Barrx Medical talking about developing clinical strategies combining the two procedures - i.e. performing Barrx to ablate the metaplastic mucosa and then performing the TIF to fix the underlying issue of LES incompetence. 


Posted By: twix38
Date Posted: 18áSepá2009 at 4:27pm
thank you egoodman,

That helps clear up some confusion.

I think I need to see more data from more TIF procedures as I am bound to go on the UK best practice and advice, as exclusion will of course be for a reason, even if only demonstrating caution because it is a relatively new procedure. If it all comes out well with TIF, then a tie up with Barrx sounds like a very exciting proposal for Barratt's sufferers, but too early to tell. Barrx itself still needs further historical data to follow up on and demonstrate (i.e. buried glands 3,4,5 years down the road and suitability for LGD and/or non dysplastic) .

I will keep a look out as this pairing sounds like a potential winner, so long as both practices prove themselves over time with more years to evaluate outcomes.

1,000 is not many at all and how long has the maximum follow up period been to date? I would rather await a minimum of tens of thousands with 3+ years histology data for outcome, comparision, problems etc

Please bear in mind all my above comments are also related to my being non dysplastic in relation to Barratts and the TIF rollout being contra indicated in UK for Barratts for now.

Watching and waiting with interest and hope for a future TIF/Barrx partnership.



Print Page | Close Window