A HALO procedure is a type of radiofrequency ablation used to treat Barrett’s esophagus, a condition where the lining of your esophagus changes into tissue that resembles the intestinal lining. This abnormal tissue can progress to esophageal cancer, and the HALO procedure uses controlled heat energy to destroy it so healthy tissue can regrow in its place. The ablation itself takes about 30 minutes, is done on an outpatient basis, and typically requires multiple sessions spaced a few months apart.
It’s worth noting that “halo procedure” can also refer to the application of a halo brace for spinal injuries, a completely different device that immobilizes the upper neck and skull. This article covers the Barrett’s esophagus procedure, which is the more common search.
Why the Procedure Is Done
Barrett’s esophagus develops in some people with long-term acid reflux. Over time, stomach acid damages the normal esophageal lining, and the body replaces it with tissue that looks more like what lines the intestines. This change, called intestinal metaplasia, isn’t dangerous on its own in most cases. The concern is when that tissue begins showing abnormal cell growth, known as dysplasia, which is a precancerous stage.
Your doctor may recommend a HALO procedure if biopsies show dysplasia in your Barrett’s tissue, whether low-grade or high-grade. A family history of esophageal cancer from Barrett’s can also factor into the decision. The goal is to eliminate the abnormal tissue before it has a chance to become cancerous.
How the Procedure Works
You’ll be sedated through an IV, and your throat may be numbed with a gargle before the procedure begins. Your doctor inserts a thin, flexible tube (an endoscope) through your mouth and into your esophagus. A camera on the endoscope sends images to a monitor so the doctor can see the Barrett’s tissue directly.
The system uses two different devices depending on how much abnormal tissue needs treatment. For large areas of Barrett’s that wrap around the full circumference of the esophagus, the HALO 360 device is used first. This is a balloon covered in tiny electrodes that inflates inside the esophagus and delivers a uniform burst of radiofrequency energy, essentially burning away the thin surface layer of diseased tissue. For smaller or patchy areas, the HALO 90 device attaches directly to the tip of the endoscope and treats targeted sections without needing a balloon.
Most patients start with a HALO 360 treatment and then return about three months later for a follow-up session. By that point, the remaining Barrett’s tissue is usually in smaller patches, so the HALO 90 device handles the cleanup. It’s common to need two or more treatment sessions to fully clear the abnormal tissue.
What Recovery Looks Like
Because you’ll be sedated, you won’t be able to drive yourself home. For the rest of that day, you should avoid alcohol.
In the days after the procedure, expect a sore throat, some difficulty swallowing, mild nausea, and chest discomfort. In clinical trials, patients rated their chest pain at about 23 out of 100 on the day of the procedure, and that pain typically dropped to zero by day eight. A low-grade fever is also possible but resolves on its own.
For the first week, you’ll start with a liquid diet, avoiding very hot or very cold drinks. As swallowing improves, you can transition to soft foods: things that are moist, easy to chew, and easy to swallow, like mashed potatoes, yogurt, or scrambled eggs. Your doctor will give you specific guidance on when to return to a normal diet.
Success Rates
The HALO procedure has a strong track record. For patients with low-grade dysplasia, studies consistently show that the abnormal cell changes are eliminated in roughly 90% to 100% of cases. Complete clearance of the intestinal metaplasia itself (meaning the Barrett’s tissue is fully gone, not just the precancerous changes) ranges from about 77% to 91%, depending on the study and the extent of the original Barrett’s segment.
For patients with high-grade dysplasia, the more advanced precancerous stage, success rates for clearing dysplasia range from about 80% to 97%. Clearing all of the Barrett’s tissue in these patients is somewhat harder, with rates ranging from 49% to 96%. In a large UK registry tracking real-world outcomes, complete clearance of dysplasia was achieved in 81% of patients with high-grade changes, and full clearance of Barrett’s tissue in 62%.
Importantly, the results tend to last. In one trial that followed patients after treatment, 98% of those who achieved dysplasia clearance maintained it over the follow-up period, and 90% maintained full clearance of the Barrett’s tissue.
Risks and Side Effects
The most common complication is esophageal narrowing (stricture), which occurs in about 5% to 10% of patients. Strictures happen because the healing process can cause scar tissue to form, tightening the esophagus. When this occurs, it’s usually treatable with a simple dilation procedure to stretch the area back open.
A large review of over 9,200 patients found the overall rate of complications from the procedure was 8.8%. Strictures accounted for 5.6% of those events, bleeding for 1%, and perforation (a tear in the esophageal wall) for 0.6%. Clinically significant bleeding is rare, and perforation, while serious, is uncommon.
Chest discomfort after the procedure is nearly universal but mild and short-lived, generally resolving within a week.
The Halo Brace (Spinal Procedure)
If you searched “halo procedure” in relation to a neck or spine injury, you’re likely looking for information on the halo brace. This is a rigid metal ring that’s fixed to the skull with small pins and connected by metal bars to a vest worn on the torso. It provides the most rigid form of external immobilization for the upper cervical spine. Doctors use it to treat certain upper neck fractures, to correct spinal deformities before surgery, or to stabilize the spine after an operation. It’s an entirely separate procedure from the Barrett’s esophagus treatment described above.