Should your gastroenterologist see what looks like Barrett’s esophagus, she or he will take multiple biopsies. The pathologist can determine if it's Barrett’s and if there is dysplasia present, an irregularity of the nuclei of the cells that may foreshadow transformation to cancer.
Dysplasia comes in mild, moderate, and severe grades, and it is the severe which presents a more immediate precursor to cancer. With severe dysplasia, several options for management are available: Watchful waiting with repeat endoscopy after a couple months on strong acid-suppressing medications (a hard decision to make, as cancer may progress rapidly from high grade dysplasia), or the “gold standard” therapy esophagectomy (surgical removal of the esophagus with transposition of the stomach into the chest and attachment at the back of the throat), and some of the investigational endoscopic options, including:
Photodynamic therapy (PDT): A photo (light) sensitizing agent is infused into a vein, and 48 hours later an endoscope bathes the sensitized cells of your esophagus with non-heat producing red laser light, frying the Barrett’s cells. With this therapy you must protect your entire body from sunlight (think burka-level of sun protection) for about six weeks after each treatment.
Endoscopic mucosal resection (EMR): In this endoscopic therapy, an area of Barrett’s is raised up by injecting fluid under it, and then cautery is used to snare it off as if it were a polyp.
Endoscopic thermal ablation: Electric heat probes or heat-generating lasers are used to burn off the Barrett’s lining
BarRX procedure: A radiofrequency probe with balloon attachment is inflated in the esophagus to cook the Barrett’s lining, in much the same way that your microwave pops a bag of popcorn. PDT and BarRx are FDA approved; all of the methods are under investigation. The results with these techniques remain mixed, so at this point none is a clear winner. Should you wish to pursue endoscopic treatment of your high grade dysplasia, discover which gastroenterologists in your area have an expertise in one of the methods. Then learn more about it, and choose wisely.
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