Patients can now be treated without surgery for precancerous conditions of the esophagus at the Queen's Medical Center.

Art Ushijima, Queen's president and chief executive officer, said the treatment “;will allow our gastroenterologists to better treat and manage their patients with the disease known as Barrett's esophagus.”;

Gastroesophageal reflux disease occurs when stomach contents back up into the esophagus. It is a major contributor to Barrett's esophagus, a precancerous condition, said Dr. Christopher Aoki, gastroenterologist.

Millions of Americans suffer from the disease, commonly known as acid reflux, according to medical reports. Abnormal cells (Barrett's tissue) replace the normal esophageal lining, putting the patient at high risk for developing cancer of the esophagus. Heartburn is the major symptom.

Surgery has been the only option available in Hawaii for Barrett's esophagus, Aoki said.

He has introduced a nonsurgical endoscopic technique at Queen's, removing the diseased tissue with radiofrequency ablation. He uses HALO systems of BARRX Medical Inc., with catheters delivering energy to destroy the abnormal cells without destroying the normal tissue.

“;You eliminate tissue, but you don't go deep enough to cause a problem with stricturing (narrowing or closing the opening of the swallowing tube leading to the stomach),”; he said.

A clinical study published recently in the New England Journal of Medicine reported that tissue removal using the HALO system is highly effective for eradicating the precancerous esophageal condition.

The therapy reduced the risk of progressing to cancer in the highest-risk patients to 2.4 percent from 19 percent, the study found.

Aoki, 36, went to the University of Hawaii medical school, the University of Washington and the University of California at Davis, where he did his residency and had a fellowship for four years.

He returned to Hawaii last year, joined Queen's and used the new treatment on his first Hawaii patients Aug. 8. Both had symptoms of heartburn, he said.

However, he pointed out, “;A certain percentage of the population get it without any heartburn symptoms. Those are the ones you really worry about,”; he said, because “;methods of detection now are very crude.”;

He and others are trying to develop a blood test to detect people at risk. The condition is identified now only with endoscopy, he said.

“;It used to be that anyone over 50 with heartburn should have screening endoscopy,”; he said. However, guidelines have changed, he said. Statistics indicate not everyone with heartburn has Barrett's esophagus, and not everyone with that condition has symptoms, he said.

It is up to the doctors now to decide on a case-by-case basis whether to recommend endoscopy screening, he said.

Aoki said Queen's will be part of a national registry to study the BARRX procedure for Barrett's esophagus. “;Once we start enrolling patients in the study, we may be able to get a better handle on incidence prevalence in Hawaii,”; he said.

It is thought of as more of a Caucasian disease, he said. “;But anecdotally I feel I'm seeing it more in Asian-Pacific Islander populations.”; One of his first two Hawaii patients was Filipino Chinese, and the other was Caucasian, he said.