How is Barrett's esophagus treated?

Once Barrett’s esophagus is identified, radiofrequency ablation (RFA) can be conducted to reduce likelihood that Barrett’s esophagus will progress to cancer. This intervention is called Barrx™ radiofrequency ablation. Radio waves are delivered via a catheter in the esophagus to remove diseased tissue while minimizing injury to healthy tissue of the esophagus. The patient then can have a surgical procedure to address the weakness of the valve with a Nissen, or Toupet fundoplication. This is the same approach used for any patient that has a complication from GERD. First address the complication, then fix the problem.

The most important treatment of Barrett’s esophagus is knowledge that you have the condition as well as being checked often by your doctor. Additionally, your gastroenterologist will prescribe a medication to reduce acid production by the stomach called a proton pump inhibitor (PPI) which minimizes the irritation of the esophagus from the acid.

Barrett’s esophagus is the replacement of the normal esophagus lining by a lining that can lead to esophageal cancer. Although the risk of developing cancer from Barrett’s esophagus is low, if there are pre-cancerous cells, there are new endoscopic techniques that allow removal of the cells without surgery. Be sure to ask your gastroenterologist about these options.

The management of Barrett's esophagus has undergone dramatic changes in the last few years. Patients will most likely undergo aggressive treatment of acid reflux symptoms with either PPI medications or antireflux surgery. Lifetime surveillance is also used to determine if the Barrett cells change. Some research suggests that surgery to stop reflux can stabilize Barrett's esophagus, and sometimes even make it return it to normal. There are several new technologies that show considerable promise. One is called Endoscopic Mucosal Resection (EMR), where a large tuft of the tissue is removed and examined. Another, endoscopic radiofrequency ablation, uses carefully controlled heat to burn off the troubled area. These techniques are accepted for patients with dysplastic Barrett's but considered experimental for patients with regular Barretts at this point in time. 
There are some treatments available that can destroy the Barrett's tissue. These treatments may decrease the development of cancer in some patients and include heat (radiofrequency ablation, thermal ablation with argon plasma coagulation and multipolar coagulation), cold energy (cryotherapy) or the use of light and special chemicals (photodynamic therapy).

In some patients, endoscopic techniques to locally remove abnormal Barrett's tissue may also be considered (for example, endoscopic mucosal resection). It is necessary to discuss the availability and the effectiveness of these treatments with your gastroenterologist to be certain that you are a candidate.

There are potential risks from these treatments and they may not benefit the majority of patients with Barrett's esophagus. There is much research being conducted in this area; you should talk with your doctor about the latest recommendations and guidelines.
Patricia Raymond, MD
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.

Treatment varies. Patients who develop mucosal carcinoma or local lesions of high-grade dysplasia (abnormal cells) can benefit from endoscopic mucosal resection (EMR). Using an endoscope, physicians can treat abnormal areas by injecting solution under the lining of the Barrett's area and applying suction to remove the abnormal tissue. While this procedure cannot always remove all of the Barrett's lining, it can be used to remove a small cancer or a localized area of high-grade dysplasia.

If EMR is used to treat an early-stage cancer, our specialists will perform an endoscopic ultrasound beforehand to make sure that the cancer involves only the very top layer of cells and is, therefore, an intramucosal cancer – one located on the top mucous layer of esophageal cells. EMR can provide a definitive proof of the tumor's depth. Healing usually takes about 4-8 weeks; risks of this procedure include bleeding.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.