Barretts Esophagus is a condition affecting the lining of the esophagus the swallowing tube that carries foods and liquids from the mouth to the stomach. Barretts Esophagus is caused by injury to the esophagus from the chronic backwash of stomach contents (like acid and enzymes) that occurs with acid reflux. There are no symptoms specific to Barretts Esophagus, other than the typical symptoms of acid reflux (or GERD).
Barretts Esophagus is characterized by a change in the appearance of the esophagus lining from pearly white to a salmon pink color. The diagnosis is confirmed with biopsies that demonstrate changes in the normal esophageal lining cell types. The initial changes in the cell types are described as Metaplasia. As the condition progress, the cells can become more abnormal or Dysplastic. Barretts Esophagus has long been established as a pre-cancerous condition of the esophagus and, traditionally, its management has been limited to monitoring the condition with endoscopy using the modified Seattle Protocol with the hope that the disease would not progress to cancer.
DIAGNOSTIC AND TREATMENT OPTIONS
- Volumetric Laser Endomicroscopy (VLE) This diagnostic technology evaluates the lining of the esophagus in patients with Barrett’s Esophagus and provides an in-time microscopic assessment of the lining. Areas of suspicion that are not visible with conventional imaging during a standard endoscopy exam can then be marked with a laser and subsequently biopsied directly. This technology results in the most accurate assessment of patients with this pre-malignant condition.
- LINX The first step is to properly treatment GERD. We have the ability to properly address acid exposure in the lower esophagus with anti-reflux surgery using the Linx system to augment the lower esophageal sphincter. There is recent published data to demonstrate that the Linx procedure is associated with regression (>80%) of short segment Barrett’s disease.
- Barrx 360 Radiofrequency Ablation A highly-specialized endoscopic technique used to treat patients with Barretts Esophagus. It utilizes a bipolar radiofrequency energy system designed to deliver precise energy to the surface layer of the lining of the esophageal. If the local conditions are controlled for acid exposure, the tissue layer will re-grow as the normal lining of the esophagus. Barrx has been shown to cure Barrett’s disease in more than 90% of patients and has become the standard of care for patients with Low-Grade and High-Grade Dysplasia, those with the fastest growing amount of abnormal cells who have the highest risk of developing cancer.
- Endoscopic Mucosal Resection Some patients will develop nodules within the areas of Barretts Esophagus. These nodules do not generally respond to ablation therapy and are addressed in a different manner. This newer minimally invasive endoscopic procedure has been developed to help these patients and is performed as an outpatient under sedation. A flexible tube is inserted into the esophagus via the mouth allowing the endoscopist to remove the area of the esophageal lining of the esophagus. This low-risk procedure allows the patient to eat and live normally.