Surgical Management Of Barrett's Esophagus
Procedures to Remove the Mucus Lining. Various techniques or devices have been developed to remove the mucus lining of the esophagus. The intention is to remove early cancerous or precancerous tissue (high-grade dysplasia) and allow regrowth of new and hopefully healthy tissue in the esophagus.
Such techniques include photodynamic therapy (PDT), surgical removal of the abnormal lining, or ablation techniques, such as the use of laser, to destroy the abnormal lining. These techniques are done using an endoscope.
Patients with Barrett's esophagus who are most likely to benefit from these techniques have:
- A type of cancer of the esophagus called adenocarcinoma, but only when the cancer has not invaded deeper than the mucosal lining of the esophagus
- Pre-cancerous tissue called high-grade dysplasia
Unfortunately, the benefits do not last in all patients. These procedures also carry potential complications, such as swallowing problems, which patients should discuss with their physician.
Esophagectomy. Esophagectomy is the surgical removal of all or part of the esophagus. Patients with Barrett's esophagus who are otherwise healthy are candidates for this procedure if biopsies show they have high-grade dysplasia or cancer. After the esophagus is removed, a new conduit for foods and fluids must be created to replace the esophagus. Alternatives include the stomach, colon, and a part of the small intestine called the jejunum. The stomach is the optimal choice.
Surgery for GERD
Review Date: 07/11/2010
Reviewed By: Reviewed by: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.