What is Barrett's Esophagus?
The esophagus functions as a conduit for food once it is chewed and swallowed. Barrett's esophagus is a precancerous condition that affects about 1 percent of adults in the United States and is more common in men than in women. It is currently believed to be a consequence of long-standing gastroesophageal reflux disease (GERD). Barrett's esophagus occurs when the normal lining (epithelium) of the esophagus is replaced by tissue similar to what lines the intestine. This abnormal tissue in the esophagus is known as "intestinal metaplasia." If left untreated, over time the intestinal metaplasia can turn into more severely abnormal tissue, termed "dysplasia." Dysplasia is graded as low, intermediate, and high.
What symptoms are associated with this condition?
Barrett's esophagus itself does not specifically cause symptoms. However, many individuals with Barrett's esophagus may have symptoms of heartburn, indigestion, or a sour taste in the mouth, which are symptoms associated with GERD.
How is Barrett's esophagus diagnosed?
Barrett's esophagus can only be diagnosed by having a gastroenterologist perform an upper endoscopic examination of the esophagus. At the time of the examination, your gastroenterologist will be able to see abnormal areas of tissue which may indicate Barrett's esophagus. Tissue biopsies can then be taken of the area and are sent to a pathologist to review. The pathologist then confirms the presence or absence of intestinal metaplasia and determines the degree or grade of dysplasia (low, intermediate, or high).
Other tests that may be used to diagnose Barrett's esophagus include:
- Chromoendoscopy: The doctor applies a stain or dye to tissue in the esophagus to enhance its appearance and distinguish between normal and abnormal tissue. Chromoendoscopy can aid the diagnosis of Barrett's esophagus and esophageal cancer.
- Narrow band imaging (NBI): With this endoscopic technique, doctors use a special system to capture high-resolution images of the inner surface of the esophagus without the use of dyes. NBI relies on the fact that light of different wavelengths penetrates tissue at different depths. The longer the wavelength, the deeper the tissue penetration. Blue light penetrates superficially, while red light penetrates more deeply. By using light of different wavelengths, doctors can see fine features of tissue in the esophagus.
What testing and treatments are available?
There are many potential therapies for Barrett's esophagus. The goal of these therapies is to preemptively remove or destroy the abnormal lining of the esophagus before the cells turn into cancer. These modalities are discussed below.
Radiofrequency ablation (RFA)
A relatively newer therapy for Barrett's esophagus is radiofrequency ablation, or RFA. This method uses thermal (heat) energy to destroy the abnormal cells lining the esophagus. The heat energy does not penetrate deeply, and therefore, it has been found to be a safe method to treat Barrett's. Additionally, in recent studies, it has been proven to be effective in the long-term in patients with Barrett's esophagus that contains dysplasia. After three years, a vast majority of patients demonstrate evidence of complete eradication of Barrett's following RFA.
Endoscopic ultrasound (EUS)
The use of endoscopic ultrasound to assess Barrett's esophagus is sometimes necessary. This test is used to take a detailed look at the different layers of the esophagus. It is accomplished via an endoscope, just like routine upper endoscopy. The difference is the presence of an ultrasound probe at the tip of the scope. The test is performed in patients with "nodular" Barrett's. The term "nodular" refers to a raised area of tissue located near or within the Barrett's esophagus tissue. These raised or nodular areas are often a concern because they may contain higher levels of dysplasia and even cancer. The ultrasound can tell your gastroenterologist how deep the nodule is in the esophagus and whether it can be safely removed. It also permits the gastroenterologist to look at lymph nodes in the area and sample them if they appear abnormal. (See EUS-FNA of mediastinal lymph nodes)
Our center offers cryotherapy, a new endoscopic procedure being used to help treat Barrett's esophagus. Cryotherapy involves the use of a super-cooled liquid or gas to freeze abnormal (dysplastic) cells found within Barrett's esophagus. In certain circumstances (such as patients who cannot have surgery), it may be used to treat small cancers in the esophagus. Additionally, it may be used to treat patients in whom radiofrequency ablation has failed. Many studies remain to be done on the long-term efficacy of cryotherapy, but preliminary results are very encouraging.
Endoscopic mucosal resection
Endoscopic mucosal resection (EMR) is a technique used to remove raised (nodular) or depressed areas of Barrett's esophagus. These areas have the most potential to contain cancer cells and also higher grades of dysplasia. Removal is accomplished by placing a small rubber band around the tissue after it has been suctioned into a cap at the end of the endoscope. Once the area of concern has been banded, a "snare" is inserted and closed around the tissue. Electrocautery (heat) is then applied through the metal snare to cut the tissue out of the esophagus. The area is then allowed to heal, and in a few weeks, treatment with radiofrequency ablation can begin. In some cases, the cancerous area is too large to remove, and surgery becomes an option for some individuals.
Endoscopic submucosal dissection
Endoscopic submucosal dissection is a new technology to remove superficial cancer or precancerous lesions after careful dissection, with a small knife used during endoscopy.
For more about these procedures, visit the Advanced Interventional Endoscopy page.
In the case of large lesions or those deep within the esophagus, your doctor may have you see a thoracic surgeon to consider minimally invasive surgery to remove the lesion. In some instances, removal of a portion (or all) of the esophagus (esophagectomy) must be performed. Our thoracic surgeons are highly skilled in performing the full range of surgical techniques.
How can I make an appointment to see an advanced endoscopist?
Our specialists are experienced in diagnosing and treating esophageal disorders. An interdisciplinary team of gastrointestinal specialists in endoscopy, radiology, and surgery work together as a team to provide each patient with coordinated, advanced, and individualized care. Please contact our Advanced Interventional Endoscopy team to discuss your case.