Treatment Of Barrett's Esophagus
Written by Dr. Steven A. Gorcey
Barrett’s esophagus is a condition where part of the lining of the esophagus undergoes a change from one cell type (squamous cell) to another (columnar cell). This change is a result of chronic injury to the esophagus from gastroesophageal reflux disease (GERD). Patients with Barrett’s esophagus have an increased risk of developing esophageal cancer. The progression to esophageal cancer typically occurs by some cells in the barrett’s segment becoming more abnormal and atypical, which is called “dysplasia” in medical terms. Patients with this condition usually have their esophagus surveyed every few years to see if they are developing any signs of dysplasia.
Traditionally, the only way to remove the dysplasia before it turned into cancer was by surgery, where the patient would have either a part or the whole esophagus removed. Now Monmouth Gastroenterology is pleased to offer some techniques where both the dysplasia and the barrett’s esophagus can be treated without the need for surgery.
The technique is radiofrequency ablation. Through using a device either mounted on a balloon or the tip of the endoscope, heat energy is applied to the barrett’s segment. The procedure is done in the setting of an outpatient upper endoscopy, usually taking between 30 to 60 minutes. More than one treatment may be required to eradicate the dysplasia and barrett’s tissue. Complications from this procedure include mucosal laceration, esophageal perforation, infection, bleeding, and stricture formation. The overall complication rate is well under 1%.
Endoscopic Mucosal Resection
In some patients with barrett’s esophagus, there can a raised or depressed area in the esophagus. In this setting, removing the abnormal area using a technique called “endoscopic mucosal resection” can usually be performed. The physician will first attempt to lift the abnormal area or spot by either injecting a water based solution into the tissue or placing a rubber-like band. The physician will the resect it using a snare (wire loop) with cautery (heat energy). The procedure is done in the setting of an outpatient upper endoscopy, usually taking between 30 to 60 minutes. Complications from this procedure include mucosal laceration, esophageal perforation, infection, bleeding, and stricture formation.