Barrett’s Esophagus: Endoscopic Surveillance and Treatment Options

A: There are many treatment options available for patients with Barrett's esophagus with high-grade dysplasia. Although most definitive, surgical treatment via esophagectomy (removal of part of the esophagus) for Barrett's with high-grade dysplasia is a controversial and very aggressive surgery. Typically patients will be hospitalized for over two weeks, and there is a high incidence of pneumonia, infection and heart attack. Depending on your age and other medical problems, there are several options available. While I will list a few of them briefly here, it is very important to discuss these with your physician. Additionally, most of these procedures are not done at community hospitals and only at specialized academic centers. This should also be discussed with your gastroenterologist and proper referrals to these institutions should be made when appropriate.

Ablation. Removal of dysplasia, or ablation, makes can reverse Barrett's esophagus and it may prevent esophageal cancer. Combined with medication, ablation may be appropriate especially if you're not a good candidate for an esophagectomy. Ablation procedures include:

• Photodynamic therapy (PDT). First, you'll be injected with a drug called porfimer sodium (Photofrin) that makes the Barrett's cells sensitive to light. Then, your doctor inserts a specialized light source into your esophagus. The light causes a reaction with the Photofrin that destroys Barrett's cells.
• Electrocautery. Your doctor inserts an electric wire into your esophagus to burn away dysplasia.
• Laser therapy. Your doctor uses a hot beam of light (laser) inserted into your esophagus to burn away Barrett's cells.
• Argon plasma coagulation. Your doctor releases a jet of argon gas into your esophagus along with an electric current to burn away dysplasia.
• Endoscopic mucosal resection. Using an endoscope, your doctor injects a saline solution under the area of your esophagus that contains dysplasia. A blister forms under these abnormal cells, allowing your doctor to cut or suction the abnormal area away from the underlying tissue without damaging the rest of your esophagus. Your doctor may recommend following this procedure with photodynamic therapy.

We hope you find this general medical and health information useful, but this Q&A is meant to support and NOT replace the professional medical advice you receive from your doctor. For all personal medical and health matters, including decisions about diagnoses, medications and other treatment options, you should always consult your doctor.