Endoscopic Management of Barret's Esophagus
Barret’s esophagus is a condition characterized by changes in the lining of the esophagus to resemble that of the intestine. It usually occurs as a complication of prolonged gastroesophageal reflux disease where the acidic contents of the stomach spill upwards into the esophagus. Barret’s esophagus does not cause any symptoms; however, it does increase your risk of developing esophageal cancer.
There are different endoscopic methods for the management of Barret’s esophagus. The goal of these methods is to avoid cancer or the need for open surgery. The various options include:
- Radiofrequency Ablation: An electrode mounted on an endoscope is used to deliver thermal energy to the mucosal lining that has undergone changes consistent with Barret’s esophagus. This has proven to be a very safe and effective method of eradicating Barret’s esophagus.
- Endoscopic Mucosal Resection: A snare is delivered through the endoscope to the suspicious area in the esophagus. The mucosal lining is then removed using the snare. This method is only indicated for patients with focal areas of Barret’s esophagus as treating widespread areas of Barret’s esophagus using this method can result in complications.
- Photodynamic Therapy: A drug is first injected into the vein which makes the diseased mucosal lining sensitive to laser light.After 24 to 48 hours, laser light is then delivered to the Barret’s esophagus through an endoscope resulting in specific destruction of the diseased tissue.
- Cryotherapy: Cold nitrogen or carbon dioxide gas is supplied to the diseased mucosal lining of the esophagus resulting in freezing and destruction of the abnormal cells. This is a relatively new treatment method.
In the past, surgery was performed to treat Barret’s esophagus before it advanced to cancer which could require more complicated surgery. Over the last few years, however, endoscopic management has become the treatment of choice for advanced Barret’s esophagus and early stages of esophageal cancer.