Barrett's Esophagus

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Barrett’s esophagus is a condition where part of the lining of the  esophagus undergoes a change from one cell type (squamous cell) to  another (columnar cell). This change is a result of chronic injury to  the esophagus from gastroesophageal reflux disease (GERD). Patients with  Barrett’s esophagus have an increased risk of developing esophageal  cancer. The progression to esophageal cancer typically occurs by some  cells in the barrett’s segment becoming more abnormal and atypical,  which is called “dysplasia” in medical terms. Patients with this  condition usually have their esophagus surveyed every few years to see  if they are developing any signs of dysplasia.

Traditionally, the only way to remove the dysplasia before it turned  into cancer was by surgery, where the patient would have either a part  or the whole esophagus removed. Dr Gorcey  is pleased  to offer some techniques where both the dysplasia and the barrett’s  esophagus can be treated without the need for surgery. 

The technique is radio frequency ablation. Through using a device  either mounted on a balloon or the tip of the endoscope, heat energy is  applied to the barrett’s segment. The procedure is done in the setting  of an outpatient upper endoscopy, usually taking between 30 to 60  minutes. More than one treatment  may be required to eradicate the  dysplasia and barrett’s tissue. The overall complication rate is well under  1%.

In some patients with barrett’s esophagus, there can a raised or  depressed area in the esophagus. In this setting, removing the abnormal  area using a technique called “endoscopic mucosal resection” can usually  be performed. The physician will first attempt to lift the abnormal  area or spot by either injecting a water based solution into the tissue  or placing a rubber-like band. The physician will then resect it using a  snare (wire loop) with cautery (heat energy). The procedure is done in  the setting of an outpatient upper endoscopy, usually taking between 30 and 60 minutes. Complications from this procedure include mucosal  laceration, esophageal perforation, infection, bleeding, and stricture  formation.