At Memorial Sloan-Kettering, patients with Barrett's esophagus and/or gastroesophageal reflux disease (GERD) have access to a comprehensive program offering of diagnostic, treatment, and surveillance programs for these conditions.
Our doctors recommend that patients with chronic GERD have an endoscopy to screen for Barrett's esophagus. During endoscopy, the doctor examines the interior lining of the esophagus using a thin, lighted tube called an endoscope. The endoscope is inserted through the mouth and guided into the esophagus, and the camera at the end of the tube enables the doctor to see inside the esophagus. Small samples of tissue may be removed during endoscopy to be examined for cancer cells.
If Barrett's esophagus is detected, patients should have an endoscopic biopsy every two to three years as part of surveillance for precancerous cell changes called dysplasia. The extent of dysplasia is usually characterized by pathologists as either mild or low grade, or severe (high-grade dysplasia, or HGD). Patients with low-grade dysplasia should have endoscopic biopsies every six months to one year and remain on medications to reduce acid reflux.
For some patients, high-grade dysplasia indicates a strong likelihood that esophageal cancer will develop within a few years. Other patients with high-grade dysplasia at the time of endoscopic biopsy are found to already have early-stage adenocarcinoma. When esophageal cancer is detected this early, the patient's outlook is usually favorable.
Treatment Options
For patients with Barrett's esophagus and/or GERD, treatment may include antiacid/antireflux medications -- such as proton pump inhibitors (PPIs) -- or surgery. Antireflux medications help alleviate the heartburn associated with these conditions, but may not completely stop the reflux of stomach contents. For patients who need to take these medications on a daily basis but who do not wish to do so, a surgery -- called antireflux surgery -- may be an option to treat chronic esophageal reflux. Surgery may be recommended for patients with severe dysplasia to remove the tissue affected by Barrett's esophagus, unless the patient's health makes him or her unable to undergo surgery.
Memorial Sloan-Kettering also offers a minimally invasive surgical procedure that involves wrapping a portion of stomach tissue around the lower end of the esophagus to strengthen the gastroesophageal juncture and prevent digestive acids from bubbling up into the esophagus. Since this procedure is performed using the minimally invasive procedure known as laparoscopy, in which only small incisions are made in the abdomen, the patient usually needs to stay in the hospital for just one night.
Some patients with Barrett's esophagus are also candidates for a treatment known as photodynamic therapy. This form of therapy is also used to relieve esophageal obstruction from esophageal cancers that are not responding to other treatments, such as surgery, chemotherapy, or radiation therapy. Photodynamic therapy is also a useful treatment for patients who have developed high-grade dysplasia and are not good candidates for surgery. For more information about photodynamic therapy, visit the Treatment section of this cancer information overview.
There are also other new, nonsurgical approaches that are currently being evaluated in the treatment of Barrett's esophagus. To remove very small, early-stage cancers, endoscopic mucosal resection may be used to shave off tiny superficial tumors through the endoscope without the need for major surgery. Another treatment option is radiofrequency ablation, which is an endoscopic procedure used to destroy the area of high-grade dysplasia. This therapy is not very effective for tumors that have spread into the wall of the esophagus. Laser therapy may also be used to destroy the abnormal cells. These new treatments are under investigation, but may one day become important approaches to the standard treatments of early-stage cancers and precancerous lesions.
