If you have Barrett's esophagus, ask your physician about the various management options available to you depending on the severity of your Barrett's esophagus. The following are some of these options:
One option that your physician may recommend, after you have a diagnosis of Barrett's esophagus, is endoscopy with biopsy (examination of your esophagus and sampling of the tissue) at various intervals to detect progression to more severe stages of disease or cancer. The frequency at which you undergo surveillance may be dependent upon the stage (severity) of your Barrett's esophagus.
Once Barrett's esophagus progresses to cancer, removal of the esophagus may be necessary to avoid cancer related death. Called an esophagectomy, this surgery involves removing the esophagus and top part of the stomach. A portion of the stomach is then pulled up into the chest and connected to the remaining normal portion of the esophagus or pharynx, creating a "new" esophagus. Because this is a major operation, there are significant risks.
Historically, surgery has been used for certain non-cancer stages of Barrett's esophagus (high-grade dysplasia) in an effort to avoid operating on more advanced cancer stages of this disease. However, in the last 5 years most high-grade dysplasia patients and even early cancer patients are treated with endoscopic therapy rather than surgery.
A number of methods have been used for treating Barrett's esophagus as a pre-emptive strike before the development of cancer. The intent of these interventions is to avoid cancer and cancer related death, but also to avoid the need for surgery and surgical-related adverse events and death. The endoscopic therapies employ a variety of means to remove the diseased lining of the esophagus. The following section briefly summarizes them.
Radiofrequency ablation (RFA) uses an an electrode mounted either on a balloon or endoscope to deliver heat energy to the diseased lining of the esophagus. A number of studies have demonstrated that RFA safely results in a high rate of complete eradication of Barrett's esophagus, as well as reduces progression of the disease to high-grade dysplasia and cancer. Because of a favorable safety profile, studies have been performed assessing the efficacy of RFA for the earliest stages of Barrett's, as well as later stages. Click here for more information.
For areas within the Barrett's esophagus lining which are raised or depressed, and thus suspicious for cancer, a method called endoscopic mucosal resection (EMR) is used to remove the damaged lining. Using a snare delivered through an endoscope, tissue can be removed to a depth of about 2 mm and then evaluated to diagnose the seriousness of the disease. The benefit of EMR is that large biopsy specimens can be removed to render the lining flat. The disadvantage is that use of EMR for wide spread Barrett's has an unacceptable complication rate. Therefore, focal EMR for specific areas of concern has been followed 2 months later by RFA to safely and effectively remove the remainder of the Barrett's esophagus.
Photodynamic therapy (PDT) has been intended exclusively for treatment of the most severe stages of Barrett's esophagus, specifically high-grade dysplasia and early cancer. A light-sensitive drug is injected into the patient's vein 24-48 hours prior to endoscopy. The drug makes the diseased tissue sensitive to laser light. During an endoscopy, a laser light is delivered to the Barrett’s tissue through a catheter inserted into the esophagus. While still holding potential for some patients with advanced Barrett's esophagus, other treatments have become preferred in the last five years (RFA and endoscopic mucosal resection) due to their safety and effectiveness.
Cryotherapy involves spraying a super-cooled liquid or gas onto the diseased lining of the esophagus. There is a lack of clinical evidence available for this method at this time.
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