Monday, August 10, 2015
Barrett’s Esophagus: Diagnosis and Treatment
By: Mark R. Janich, MD, Birmingham Gastroenterology Associates
With an estimated 20 percent of American adults affected by Gastroesophageal Reflux Disease (GERD), both Primary Care Physicians and Gastroenterologists are daily diagnosing and treating patients with this disease. While the symptoms of GERD are troublesome, an estimated 10-15 percent of these patients will develop a serious complication, Barrett’s Esophagus.
Barrett’s esophagus is a condition in which the lining of the esophagus changes and it becomes similar to the tissue that lines the intestines. While frequency and severity of GERD does not affect the likelihood of Barrett’s, it is more likely to occur in patients who developed GERD at a young age or have had a longer duration of symptoms. Dysplasia, a precancerous change in tissue, can occur in any Barrett’s tissue. Endoscopy is utilized to diagnose Barrett’s. Biopsy confirmation is required for a definitive diagnosis, but the tissue is visible during endoscopy.
Radiofrequency ablation can safely and effectively remove the abnormal cells before they become cancer. During the procedure, a gastroenterologist inserts an endoscope down the esophagus of a sedated patient. The endoscope has an electrode pad attached to the tip that delivers short automated pulses of energy to destroy the Barrett’s tissue that lines the inner surface of the esophagus. Birmingham Gastroenterology Associates utilizes the HALO system for this procedure.
The key to this technology is the fact that the Barrett’s epithelium is approximately ½ millimeter thick, and the HALO system can deliver bipolar energy that consistently ablates to a depth of greater than ½ millimeter, but less than 1 millimeter. HALO ablation removes the Barrett’s cells, but limits damage to the surrounding healthy tissue. The superficial ablation results in an extremely low complication rate. The patient has an outpatient procedure and is home the same day.
It is recommended that patients with longstanding GERD (longer than 5 years) should undergo screening for Barrett’s. If a patient has Barrett’s without dysplasia, they should have a surveillance endoscopy every 3 years to monitor for dysplasia and early cancer. Patients with Barrett’s esophagus and dysplasia will require more frequent monitoring.
Data shows that annually 2 patients in 1000 with simple Barrett’s will progress to esophageal cancer. This number increases significantly with progressive forms of dysplasia, so the use of radiofrequency ablation for any form of dysplasia is appropriate.
Birmingham Gastroenterology Associates (www.bgapc.com) was the first group in Birmingham to utilize HALO for Barrett’s Esophagus and continually pursues the newest and best evidence-based therapies available.