The esophagus transports swallowed food and liquids to the stomach. Normally, it is lined with skin-like cells called squamous epithelial cells. With Barrett's esophagus, the normal cells at the lower end of the esophagus near the stomach are replaced by abnormal columnar epithelial cells, which are also called Barrett's cells. People with Barrett's esophagus are monitored to watch for dysplasia--abnormal changes in the Barrett's cells. A stepwise progression from low-grade to high-grade dysplasia can eventually lead to esophageal cancer.
Cancerous transformation of Barrett's esophagus is uncommon, occurring in less than 1 percent of people with the condition annually. People without dysplasia or with low-grade dysplasia do not usually require treatment but are monitored every one to three years to check for deleterious changes. Treatments for high-grade dysplasia eliminate the dysplastic Barrett's cells, thereby preventing their transformation to cancer cells.
Cryotherapy
Cryotherapy kills the dysplastic Barrett's cells by freezing them. Liquid nitrogen is the usual freezing agent. An endoscope is used for the procedure. This flexible tube inserted into the esophagus enables the doctor to see the diseased tissue and deliver the treatment. Three or more treatments several weeks apart may be need to get rid of all the diseased tissue. In their 2009 article in "Diseases of the Esophagus," Dr. Bruce Greenwald and his colleagues reported success rates of 94 percent for high-grade dysplasia and 88 percent for all esophageal dysplasia using cryotherapy.
Photodynamic Therapy
Photodynamic therapy (PDT) uses a light-activated drug to kill the dysplastic Barrett's cells. A drug called a photosensitizer is administered and absorbed by the abnormal cells over a few days. The abnormal tissue is then exposed to laser light, which activates the photosensitizing drug causing the cells to die. In a 2007 article published in "Gastrointestinal Endoscopy," Dr. Bergein Overholt and his colleagues reported a 77 percent success rate in the destruction of high-grade esophageal dysplasia using PDT.
Radiofrequency Ablation
Radiofrequency ablation (RFA) destroys abnormal Barrett's cells using heat. A small needle is inserted into the diseased area, and bursts of electrical energy heat and kill the targeted cells. Dr. Nicholas Shaheen and his colleagues reported in 2009 in "The New England Journal of Medicine" success rates of 90.5 percent and 81.0 percent for the elimination of low-grade and high-grade esophageal dysplasia, respectively.
Endoscopic Mucosal Resection
Endoscopic mucosal resection (EMR) is a procedure to remove dysplastic esophageal tissue. The procedure involves lifting the diseased lining of the esophagus off the muscular layer on which it sits, and cutting out the abnormal tissue. This is done through an endoscope placed in the esophagus. In a 2010 article published in "The American Journal of Gastroenterology," Dr. Michael Bourke and his colleagues reported a 94 percent success rate using EMR for the treatment of Barrett's esophagus.
Esophagectomy
For people with severe high-grade dysplasia, surgical removal of most of the esophagus (an esophagectomy) may be recommended. This procedure involves removal of the diseased esophagus and reconstruction to attach the stomach to what remains of the esophagus.
References
- "Harrison's Principles of Internal Medicine, 16th Edition"; Anthony S. Fauci, M.D., Eugene Braunwald, M.D., J. Larry Jameson, M.D., Ph.D., Dennis L. Kasper, M.D., Stephen L. Hauser, M.D., Dan L. Longo, M.D., Editors; 2004
- National Institute of Diabetes and Digestive and Kidney Diseases: Barrett's esophagus
- The Society of Thoracic Surgeons: Barrett's esophagus
- American Cancer Society: Can cancer of the esophagus be found early?
- Mayo Clinic: Barrett's esophagus treatment
