Therapeutic endoscopy · London
Radiofrequency ablation (RFA) for Barrett’s oesophagus - private in London.
A day-case Barrx HALO ablation course for Barrett’s with dysplasia - staged over 6 to 12 months by a therapeutic endoscopist running a dedicated Barrett’s programme, in a JAG-accredited London unit, with EMR and ESD in the same room if the mapping scope finds a nodule.
Why patients choose us
- 01
A specialist Barrett’s endoscopist, in a high-volume unit
Not a general upper GI list. A named therapeutic endoscopist running a dedicated Barrett’s programme, in a JAG-accredited unit that meets BSG standards.
- 02
The right ablation - or the right resection first
RFA is for flat Barrett’s. Nodules need EMR or ESD first. We check the mapping scope before we book you for ablation.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private RFA course costs in London.
Indicative ranges across our London partner units. Send the mapping scope report and we quote firm figures across two or three options.
In short
A full RFA course in our London network: £12,000–£28,000, staged over 6 to 12 months.
| Procedure | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Mapping gastroscopy with NBI and Seattle-protocol biopsies | £1,200–£2,200 | 30–45 min | Same visit |
| RFA session - focal HALO 90 (short-segment Barrett’s) | £4,500–£6,000 | 30–45 min | Same visit |
| RFA session - circumferential HALO 360 (long-segment) | £5,500–£7,500 | 40–60 min | Same visit |
| Full course - short-segment Barrett’s (2–3 sessions) | £12,000–£18,000 | 6–9 months | Staged |
| Full course - long-segment Barrett’s (3–4 sessions) | £18,000–£28,000 | 9–12 months | Staged |
| Second-opinion review of prior scope and histology | £250–£450 | 30 min | 48 hours |
Prices vary by unit, by which endoscopist runs the case, by whether anaesthetist-delivered propofol is used, and by the Prague length of your Barrett’s segment. We come back with a firm quote within one working day.
What RFA actually is
Endoscopic thermal ablation - the Barrett’s mucosa off, normal squamous back on.
RFA uses Barrx HALO circumferential or focal catheters at 12 J/cm² to destroy Barrett’s mucosa. Under a high-dose PPI, normal squamous mucosa regrows in its place over 2 to 3 months, and the segment shortens session by session until it is gone.
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Is RFA even the right procedure?
A Barrett’s segment with a visible nodule needs EMR or ESD first - RFA never treats a nodule, only flat mucosa.
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Worried about complications?
Chest soreness for a week, stricture in 5 to 8%, perforation under 1% - quoted honestly, with a 24/7 contact plan, before you consent.
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Want it done in a specialist unit?
A named therapeutic endoscopist running a dedicated Barrett’s programme, in a JAG-accredited London unit, with EMR and ESD in the same room.
The journey
From referral to eradication - what happens, in order.
One team from first message to complete eradication and long-term surveillance - including the mapping scope, the sessions and the follow-up.
Phase 1 · Before your first session
Concierge, off-stage for you
Phase 2 · On the day
A few hours at the unit
Phase 3 · After
Concierge, back on
- 01
Before
You send us the referral or scope report
A short, confidential form. Prague C and M length, any visible nodules, the dysplasia grade, and prior histology if available.
- 02
Before
We come back with a recommendation
Within one working day: whether RFA fits, whether EMR or ESD comes first, and how many sessions to budget for. An honest read either way.
- 03
Before
We arrange the mapping scope
A high-resolution gastroscopy with NBI and Seattle-protocol biopsies confirms extent and grade before the first ablation is booked.
- 04
On the day
Arrival at the unit
Consent, a chat with the endoscopist and anaesthetist, and either conscious sedation or propofol. You are home the same day.
- 05
On the day
The RFA itself
30 to 45 minutes. Barrx HALO 360 for circumferential Barrett’s, HALO 90 or channel RFA for focal islands, at 12 J/cm², two applications per zone.
- 06
On the day
Home the same day
A short recovery, sucralfate and high-dose PPI, and written aftercare. Someone collects you after sedation.
- 07
After
Repeat sessions and surveillance
Repeat RFA every 2 to 3 months until complete eradication, then a surveillance scope at 3, 6 and 12 months, and annually thereafter.
Typical end-to-end: 6 to 12 months for the RFA course. Sessions: 2 to 4. Surveillance thereafter: annual.
When it helps
When RFA is the right step - and when it is not.
The Barrett’s pictures that lead to RFA - and the ones where EMR, ESD, surgery or plain surveillance is the safer call instead.
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Barrett’s with high-grade dysplasia (HGD)
Flat HGD without a visible nodule - the strongest indication for RFA under BSG and ESGE guidance.
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Barrett’s with confirmed low-grade dysplasia
Low-grade dysplasia confirmed by a second expert GI pathologist - RFA prevents progression to HGD and cancer.
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Indefinite for dysplasia, higher-risk patients
Persistent indefinite-for-dysplasia in a long segment, or with strong family history - selected cases benefit from ablation.
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Post-EMR or post-ESD residual flat Barrett’s
Once a visible nodule has been resected by EMR or ESD, the residual flat Barrett’s is ablated with RFA to complete eradication.
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Recurrent intestinal metaplasia after eradication
Islands or tongues that reappear at the neo-squamocolumnar junction after previous eradication - focal RFA re-treats them.
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Visible nodule on the Barrett’s segment
A Paris 0-Is, 0-IIa or 0-IIc nodule needs EMR or ESD first for histology and staging. RFA comes after, never instead.
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Invasive cancer beyond T1a
Submucosal invasion (T1b) or beyond needs oncological staging and surgical or oncological pathways, not endoscopic ablation.
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Non-dysplastic short-segment Barrett’s
Non-dysplastic Barrett’s under 3 cm is generally surveillance-only under BSG - ablation is reserved for selected higher-risk cases.
Procedure options
RFA is a family of catheters - and EMR sits before it.
What each option on the table actually involves. Circumferential HALO 360 for the first sessions on long segments, focal HALO 90 or channel RFA for touch-ups and short segments.
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Barrx HALO 360 (circumferential)
A balloon catheter delivers radiofrequency energy circumferentially around long or bulky Barrett’s segments. The workhorse first session for C2+ disease.
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Barrx HALO 90 (focal)
A small paddle mounted on the scope tip treats residual islands or short-segment Barrett’s. Used for touch-ups and short-segment C0M2 disease.
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Barrx channel RFA
A through-the-scope catheter that treats small tongues and islands without repositioning - useful for focal recurrence at the top of the wrap.
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Cryotherapy (nitrous or liquid N₂)
An alternative or salvage ablation using freezing rather than heat. Considered when RFA has failed to eradicate or has caused stricture.
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EMR before RFA
Any visible nodule on Barrett’s is resected by EMR or ESD first for histology - RFA then ablates the residual flat mucosa, never the nodule itself.
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Argon plasma coagulation (APC)
A niche option for very small tongues or islands. Not the standard for extensive Barrett’s - RFA is more uniform and better studied.
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Anti-reflux optimisation
High-dose PPI, sometimes with a nocturnal H2 blocker, is standard around RFA. Persistent reflux may need fundoplication to protect eradication.
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Second-opinion review
A specialist review of your scope, images and biopsies - sometimes the answer is another mapping scope or a change of pathway before ablation.
Where it is done in London
A small panel of Barrett’s specialists, we picked them.
Consultant therapeutic endoscopists at University College London Hospital Private, The Royal Marsden Private, HCA London Bridge, Cromwell Bupa and Imperial Private. Introductions are made privately, once we understand your case.
Selection criteria
How we choose every endoscopist in our London network.
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Therapeutic endoscopists running a dedicated Barrett’s and RFA programme
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JAG-accredited units meeting BSG standards for advanced upper GI endoscopy
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EMR, ESD and MDT referral pathways available before and around ablation
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Anaesthetist-delivered propofol for long, circumferential or awkward cases
Safety and recovery
What to expect afterwards - honestly.
Complete eradication of dysplasia is achieved in 90 to 95% of patients at 12 months, and complete eradication of intestinal metaplasia in 78 to 88%. Chest discomfort for a week, stricture in 5 to 8%, and back to office work in 2 to 3 days are what to plan for.
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Sedation with midazolam and fentanyl
Standard sedation for most RFA. Anaesthetist-delivered propofol for longer circumferential sessions or where deeper sedation makes the case safer.
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Chest discomfort for 3 to 7 days
Retrosternal soreness after ablation is expected. Regular paracetamol, sucralfate suspension and high-dose PPI settle it within a week.
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Oesophageal stricture in 5 to 8%
The main long-term complication, more common after circumferential RFA. Managed with endoscopic dilatation - usually one or two sessions.
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Perforation is very uncommon
Under 1% in modern series. Most are recognised at the procedure and closed with clips; a minority need admission.
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Bleeding is unusual
RFA is a thermal treatment on flat mucosa - bleeding rates are far lower than for EMR or ESD. A small volume of dark spotting for 24–48 hours is normal.
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Liquid diet for 24 hours
Clear fluids for 24 hours, then a soft diet for 3 to 4 days. Sucralfate suspension four times daily to coat the healing mucosa.
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High-dose PPI, twice daily
A twice-daily proton-pump inhibitor is essential around every session and long-term after eradication - low reflux is what lets squamous mucosa regrow.
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Back to office work in 2 to 3 days
Most patients are back at a desk within a couple of days. Avoid heavy lifting, hot spicy food and alcohol for a week.
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Red flags after discharge
Severe chest pain, breathlessness, fever, vomiting blood or black stools - call the unit or go to A&E the same day.
Reading your endoscopy report
Your RFA report in four parts. Read the last one first.
Whichever catheter was used, the report the endoscopist sends after each session keeps to the same shape.
A quiet reminder
Endoscopy language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the report before your review, just ask.
- 01 Header
Prague C and M length, and dysplasia grade
The extent of Barrett’s in Prague classification (C = circumferential, M = maximal), and the histology grade going in.
- 02 Technique
Catheter, energy and zones treated
Which HALO catheter was used (360, 90 or channel), the energy (typically 12 J/cm²), the number of applications per zone, and the segment covered.
- 03 Findings
Any nodules seen, and completeness
Any new or residual nodules that need EMR or ESD before the next ablation, and the endoscopist’s read on how the segment is responding.
- 04 Impression
Next session and surveillance interval
Read this first: when the next RFA is booked, PPI dose, and the surveillance plan once complete eradication is confirmed.
Recognised by major UK insurers
Cover for RFA is usually funded when there is confirmed Barrett’s dysplasia and a specialist referral - we confirm cover before booking.
Frequently asked
Everything we get asked about RFA for Barrett’s.
Quick answers on pain, sessions, recurrence, insurance, PPI and long-term cancer risk.
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Is RFA for Barrett’s painful?
The procedure itself is done under sedation, so you feel nothing. Afterwards, most patients have retrosternal chest soreness for 3 to 7 days that settles with regular paracetamol, sucralfate suspension and a high-dose proton-pump inhibitor. Severe pain, breathlessness or fever is unusual and needs to be reported.
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How many RFA sessions will I need?
Most patients need 2 to 4 sessions, spaced 2 to 3 months apart. Short-segment Barrett’s typically clears in 2 sessions; long-segment C5+ disease often takes 3 to 4. A short focal touch-up at 12 months to finish off residual islands is common.
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What is the risk of recurrence after eradication?
Around 10 to 20% of patients have some form of recurrence over 5 years - usually a small island of intestinal metaplasia at the neo-squamocolumnar junction. This is why lifelong surveillance is recommended: recurrences are almost always treated with a single focal RFA session.
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Will private medical insurance cover RFA?
Most major UK insurers - Bupa, AXA Health, Vitality, Aviva, WPA, Cigna - cover RFA when there is confirmed dysplasia and a specialist referral. Cover for non-dysplastic Barrett’s is less consistent. We confirm authorisation with your insurer before booking.
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Will I need to stay on a PPI forever?
Yes. Lifelong high-dose PPI, usually twice daily, is standard after RFA. Low acid exposure is what lets squamous mucosa regrow and stay stable - stopping PPI is one of the strongest predictors of recurrence. Some patients with persistent reflux consider fundoplication.
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What is my cancer risk after successful RFA?
Complete eradication of dysplasia by RFA reduces the risk of progression to oesophageal adenocarcinoma by roughly 90% compared with surveillance alone in HGD, and by a smaller but still significant margin in confirmed LGD. Residual risk is not zero, which is why surveillance continues indefinitely.
Ready to start
Send us the mapping scope - we come back within a working day.
Prague length, dysplasia grade, any nodules and prior histology if you have them. We match you to a therapeutic endoscopist in a JAG-accredited London unit and quote a firm figure across two or three options.
Related
Looking for something else?
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Endoscopic mucosal resection (EMR)
Resection of visible Barrett’s nodules before RFA.
Learn more -
Endoscopic submucosal dissection (ESD)
En-bloc resection for larger or deeper Barrett’s lesions.
Learn more -
Gastroscopy
The mapping and surveillance scope behind an RFA course.
Learn more -
Acid reflux
The chronic reflux behind most Barrett’s oesophagus.
Learn more