Cures for Barret's Esophagus

Barrett's esophagus is a precancerous condition of the distal esophagus diagnosed by microscopic evaluation of a biopsy specimen taken from the esophagus via a technique called upper endoscopy. Ideally, specimens should be evaluated after a course of acid suppressive therapy. Diagnosis of Barrett's esophagus is important because it is associated with an increased risk of esophageal cancer.

Risk Factors

• Barrett's esophagus is more common in men, individuals aged 40 years and older and those with chronic gastroesophageal reflux (e.g., heartburn, regurgitation or difficulty swallowing). Given that elevated body mass index is a potential contributor to the development of gastroesophageal reflux disease, the development of Barrett's esophagus is thought to be associated with obesity. However, results of studies have been conflicting, and more evidence is needed to confirm this hypothesis.

Screening

• According to American College of Gastroenterology guidelines, severity of Barrett's esophagus (i.e., grade of dysplasia) should be assessed at scheduled intervals to determine the next step in management. If initial endoscopy yields no dysplasia, the recommendation is two endoscopies with biopsies within 1 year; if both endoscopies reveal the same results, endoscopy should be repeated every 3 years. If low-grade dysplasia is found on initial endoscopy, this should be confirmed by a gastrointestinal pathologist and endoscopy and biopsy should be repeated within 6 months. If screening yields no progression to high-grade dysplasia, the individual should have an endoscopy once annually until no dysplasia is found on 2 consecutive endoscopies. For individuals with high-grade dysplasia on initial endoscopy, the finding should be confirmed by a gastrointestinal pathologist, and endoscopic resection should be considered for a better biopsy sample if there is a mucosal irregularity. Endoscopy and biopsy should be repeated every 3 months, and if high-grade dysplasia is still present, interventions such as endoscopic ablation or resection or esophagectomy should be performed.

Endoscopic Ablation

• Along with endoscopy, several techniques are used to ablate the area of dysplasia, with the goal of eradicating abnormal tissue. Radiofrequency ablation, photodynamic therapy, argon plasma coagulation and cryotherapy are all potential techniques. All patients who undergo ablation should have screening biopsies at regular intervals to ensure that the area has been completely ablated and no dysplasia is seen on at least 3 consecutive endoscopies.

Endoscopic Resection

• Resection using endoscopy is increasingly being used to treat individuals with Barrett's esophagus. During the procedure, submucosal saline and epinephrine injections with or without suction are used to target the involved area. The involved tissue is then removed. One disadvantage of this technique is that there may be residual tissue that has the potential to develop into cancer. It is incredibly important that individuals undergoing resection have scheduled endoscopic follow-up to ensure that all involved tissue has been removed.

Esophagectomy

• Esophagectomy is a procedure in which the esophagus is completely removed. Once the esophagus is removed, the surgeon creates a new esophagus from a portion of the stomach. This procedure was once the standard of care for Barrett's esophagus. However, many individuals choose resection or ablation instead of esophagectomy because of the associated complications and risk of death.