Merendino interposition surgery for T1 oesophagus or upper stomach cancer. Post op feedback available.

[medway]

Firstly I am grateful to the OPA for all there help. In return I would like to offer my comments on the op after 4 months, and after effects to anybody else in the same position as me when offered the 'full pull up' or the Merendino interposition which is not a common op and only available for T1 cancer.

Halo ablation I am informed is available for Barretts disease of the oesophagus or possibly T1.

So feel free to contacts me through this blog. I am not a doctor & can only offer my observations after the op. all decisions would be your own and you are advised to discuss my comments with your surgeon.

[Hidden]

really glad that things are going well, especially after that period of uncertainty before the operation.

I think the Merindino interposition is where the surgeon cuts out a piece of the digestion tract lower down to replace the part of the oesophagus that has been removed?

Radio frequency ablation (RFA) is indeed used to treat Barrett's Oesophagus and is relatvely new, but the results look very promising. This is often done on HALO equipment which has two different types. One of them can get into the creases of the oesophagus lining better. It is like an endoscope with something like a laser attached that 'burns' off the affected cells. There is probably a point where Barrett's oesophagus has developed into cancer where the surgeon would advise an oesophagectomy rather than RFA, and you are quite right to advise people to take the surgeon's advice.

Good luck with your continuing recovery.

[medway]

Your correct on both accounts Alan. The jejunum (lower intestine) is placed between the remaining oesophagus and remaining stomach and forms a sort of barrier to stop reflux. It was expalined to me that the jejunum is a soft wrinkled tube that stops reflux by making a difficult path. I had 10cm added. Mine has a kink which stops all reflux. When I had my last endoscopy the reflux prevention was so good they could not get the endoscope down into the stomach. Whether by design or not I do not know.

Halo ablation appears to be perhaps a step behind here than some other countries. Some countries are treating low grade upper stomach cancer as well as the oesophagus. the idea is to 'burn off' barrets disease before cancer develops and also T1 cancer of the stomach but I hasten to add there must obviously be a risk that cancer is deeper so i am sure it is not 100% successful. This may be why the stomach is not treated with ablation in the UK. i believe it is being reviewed. The other problem with halo ablation is controlling bleeding and some pain. More than one treatment is usually necessary to control this. In 2010 when I reviewed this treatment there were only 2 centres of excellent in the UK, Surrey and Glasgow.

Both these treatments are for low grade T1 cancer.

Keep up the excellent work Alan.

[chrisrob]

Fortunately there are more centres now using HALO.

You can find a list here: barrettscampaign.org.uk/hal...

It includes Southampton where Barrett's Wessex bought the machine and presented it last year.

[medway]

Thats good news. Hopefully there will be some progress in introducing it for T1 stomach cancer as well as oesophagus. As there are risks as the cancer may be deeper than Halo can treat, then I expect they will wait for further results from other countries.