After someone has had gastroesophageal reflux disease (GERD) for many years, it can advance to Barrett’s esophagus. Barrett’s is a way the esophagus defends itself: The cells in the lining of the esophagus start to change because they’ve been exposed to acid for many years. Barrett’s esophagus is considered a precancerous lesion and increases the risk for esophageal cancer. Only a small percentage of patients with Barrett’s esophagus end up developing cancer, but we monitor all of our patients and look for early warning signs. For those patients, we have a number of effective therapies that can reverse the progression.
Risk factors for Barrett’s esophagus and esophageal cancer include having had severe gastroesophageal reflux disease for a long time, being male, and being overweight or obese. Most people with GERD do not get Barrett’s esophagus, and only a small portion of people who have Barrett’s esophagus will develop esophageal cancer — about 1 percent each year.
But Barrett’s esophagus increases the risk of esophageal cancer by 125 times. So doctors recommend that people over the age of 50 with chronic GERD symptoms get screened with endoscopy, especially if they are white, overweight, and male. Endoscopy is done in a doctor’s office while under sedation, or in the hospital. Screening helps doctors figure out if you have Barrett’s esophagus or cancer.
If you do have Barrett’s esophagus, we may recommend regular endoscopy exams.
Doctors use a technique called endoscopy to diagnose and stage Barrett’s esophagus. In this test, a gastroenterologist puts a thin, flexible tube with a light and a camera at the tip, called an endoscope, through the throat to look at the lining of the esophagus. To make patients more comfortable, they are sedated with an anesthetic that wears off quickly once the test is done.
If the doctor sees the kind of changes that signal Barrett’s esophagus, she or he will take a tissue sample by passing special instruments through the endoscope. Our gastroenterologists are very experienced in endoscopy and use the latest high-definition instruments.
One of our experts will look at the biopsy under a microscope for the kind of cell changes that come with cancer. This will help us determine how far along the Barrett’s esophagus is, and whether it has become cancerous and could spread to other areas of the body.
The stages of Barrett’s esophagus are:
- non-dysplastic (no cancerous tissue present)
- low-grade dysplasia (minor cell changes found)
- high-grade dysplasia (extensive cell changes found, but not yet cancer)
- noninvasive cancer
- invasive cancer
Our team has created a database of information from hundreds of patients who have been treated for Barrett’s esophagus. This helps us assess each new patient’s risk for esophageal cancer.
One of the benefits of getting treatment for Barrett’s esophagus at Memorial Sloan Kettering is that each member of our team, who together have decades of experience, can help you decide which treatment is best for you.
Because Barrett’s esophagus is related to GERD, it’s important that patients with Barrett’s be treated for GERD with medications or surgery.
If tests indicate that your cells have not changed and that you are at low risk for esophageal cancer, we may recommend regular monitoring with an endoscopy every three years. It is important to control GERD in patients being monitored, either with medications or surgery.
However, if tests show that your cells have changed, we will likely recommend more tests, such as endoscopic ultrasound and maybe an endoscopic mucosal resection (a procedure in which abnormal tissue is shaved off). If there are any bumpy areas or anything else that looks like early cancer, we may order a CT scan or a PET scan to help determine which treatment may be best for getting rid of the cells, making you feel better, and keeping the disease from getting worse or coming back.
If we find that your esophagus has precancerous cells or cancerous cells just in the superficial lining of your esophagus (noninvasive cancer), we may recommend endoscopic therapy or surgery.
Our gastroenterologists and surgeons are experts in several endoscopic therapies for people with precancers or early-stage cancers. Some of these treatments may cure you without invasive surgery, and can help make sure the cancer won’t come back. These therapies include:
- Endoscopic mucosal resection — In this procedure, the abnormal tissue is shaved off during an endoscopy exam. This helps remove precancerous and small, early-stage cancers of the lining of the esophagus.
- Radiofrequency ablation — This delivers short bursts of radio waves through a special device that is passed through the endoscope, destroying the abnormal tissue.
- Cryoablation — In this technique, doctors use superfine catheters to deliver a very cold liquid and gas through the endoscope to freeze and destroy the abnormal cells.
- Photodynamic therapy — This method uses a light-sensitive drug and laser to destroy the abnormal cells.
- Argon plasma coagulation — In this technique, argon gas is directed at the abnormal cells through an endoscope, destroying the cells with an electric current.
Our doctors have had excellent results with these procedures, which have helped improve our treatment of Barrett’s esophagus.