BARRETT’S ESOPHAGUS / ESOPHAGEAL CANCER

BARRETT’S ESOPHAGUS

Barrett’s esophagus is a condition affecting the lining of the esophagus, the swallowing tube that carries foods and liquids from the mouth to the stomach.  Barrett’s 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 Barrett’s esophagus, other than the typical symptoms of acid reflux (or GERD).  Barrett’s esophagus has long been established as a pre-cancerous condition of the esophagus.  Traditionally, its management has been limited to monitoring the condition with endoscopy with the hope that the disease wound not progress to cancer.  This area of medicine has evolved very much in the last few years.  This is very important as the incidence of Esophageal Cancer has increased more than 400% in the past few decades.

A NEW MODEL OF CARE FOR BARRETT’S ESOPHAGUS

BETTER SCREENING FOR BARRETT’S ESOPHAGUS:

EsoGuard “Lucid Diagnostics TM” is a DNA test for detection of Barrett’s (Esophageal Pre-cancer Cells).  EsoCheck is a non-invasive test performed in the doctor’s office.  The test takes about 5 minutes to perform.  It involves using a cell collection device that is designed to collect cells from the distal esophagus without the need for endoscopy.  The cells are then sent to a specialized diagnostic testing facility for evaluation.  A positive test provides support to consider further esophageal evaluation.

BETTER ASSESSMENT OF BARRETT’ ESOPHAGUS:

The traditional method used for diagnosing Barretts Esophagus and assessing the risk of progression to cancer is a biopsy of the esophageal lining.  90% of patients diagnosed with Barrett’s Esophagus have biopsies that suggest non-dysplastic disease. A pathologist looks at the cells and classifies the abnormal cells as non-dysplastic and dysplastic.  Dysplastic cells are more likely to progress to cancer.   Unfortunately, it has been difficult to predict which patients with non-dysplastic cells will progress to dysplastic or cancer over time. 

TissueCypher “Castle Bioscience TM” uses an AI-driven algorithm leverages nine protein biomarkers and seven cellular structures to extract 15 features that have been shown to be relevant in predicting future progression of Barrett’s Esophagus to High Grade dysplasia (HGD) or esophageal cancer.  TissueCypher results provide an actionable risk score that is associated with a patient’s 5-year risk of progression.

BETTER TREATMENT OF BARRETTS ESOPHAGUS:

The treatment of Barretts Esophagus has evolved over the past twenty years with the development of new technologies specifically focused upon addressing this condition.  Barrx Radiofrequency Ablation “Medtronic TM” has been shown to cure Barrett’s disease in more than 90% of patients and has become the standard of care for patients with both Low Grade Dysplasia (LGD) and High Grade Dysplasia (HGD), those with the fastest growing amount of abnormal cells who have the highest risk of developing cancer.  More recently, Cryoablation Technology “MeritMedical Endotek TM” has gained greater acceptance due to its ability to treat Barrett’s Esophagus with less pain.

BETTER TREATMENT OF SEVERE GERD AND BARRETTS ESOPHAGUS:

The treatment of patients with a hiatal hernia, severe GERD, and Barretts Esophagus can be complicated.  We know that taking antacid medicine does not always protect patients from progression of their Barretts Esophagus.  When patients are diagnosed with Dysplasia, the treatment of the Barretts is indicated. However, it is generally understood that the treatment of Barretts with RFA is less successful in this group of patients.  Often, they don’t respond to RFA treatment when only taking antacid medication.  Alternatively, once treated, they often develop recurrent Barrett’s disease.  There is suggestion that controlling reflux with Minimally Invasive Anti-reflux surgery using the LINX device or fundoplication for patients with hiatal hernias can result in better treatment of their Barrett’s disease.

A NEW MODEL FOR ESOPHAGEAL CANCER TREATMENT

EARLY STAGE ESOPHAGEAL CANCER

Cancer occurs when the abnormal cells involved in Barrett’s esophagus have rapid and uncontrolled growth and invade the deeper layers of the esophagus.  The majority of patients in the United States with esophageal cancer have Barrett’s esophagus, although didn’t know they have it until cancer is diagnosed.

Until recently, all patients diagnosed with esophageal cancer were offered curative esophagectomy, surgery to remove the esophagus, to manage their disease.  While this treatment is very effective for early stage cancer, removing the esophagus significantly affects one’s ability to eat and live normally.  A newer minimally invasive approach has been developed to help patients with early-stage esophageal cancer.  Endoscopic Mucosal or Sub-Mucosal Resection Techniques are performed as an outpatient procedure.  A flexible tube is inserted into the esophagus via the mouth allowing the surgeon to remove a portion of the cancer from the lining of the esophagus.  This lower risk procedure allows the patient to eat and live normally Follow up care after treatment is very important and patients should schedule regular checkups regularly to make sure the cancer does not return.

LOCALLY ADVANCED ESOPHAGEAL CANCER:

Locally advanced esophageal cancer is defined as cancer that is limited to the area that would be normally be removed with surgery.  A staging evaluation is performed once a patient is diagnosed with esophageal cancer to determine if a patient is a candidate for surgery.  Once this step is completed, a patient would then typically begin pre-operative treatment using combined Chemo/Immuno therapy in order to shrink the tumor and to kill nests of microscopic disease that may have already spread.  The importance of this therapy can’t be overstated as it results in a significant improvement in long term survival.  Once this step is completed, next step involves undergoing a MIS Esophagectomy which has become the stand of care  MIS procedures result in less pain, shorter hospital stays, and faster recovery than traditional open surgery.  During this surgical procedure, part of the esophagus, which is the tube between the mouth and stomach, is removed and then reconstructed using part of another organ usually the stomach.  The minimally invasive surgical esophagectomy techniques have evolved since the early days when the entire esophagus was removed and replaced with the stomach.  Today, the surgical treatment is based upon the size and location of the tumor. 

METASTATIC ESOPHAGEAL CANCER:

Metastatic esophageal cancer is defined as cancer that has spread beyond the area that would normally be removed with surgery.  Traditionally, these patients are offered a combination of Chemo / Immuno/ Radiation therapy to treat their disease.  However, given the development of MIS surgical techniques and the improvement of medical therapies, some patients may qualify for a more aggressive treatment approach depending upon their individual circumstances.

Testimonial
“Dr. Chiasson was part of the team that literally saved my life when I was diagnosed with cancer of the gastric/esophageal junction.  His surgery was nothing short of miraculous.  There are no signs of cancer and I am now having follow-up chemo and radiation therapy.  I have a very well founded hope of complete and long-lasting recovery.  I’ve been told that this particular surgery, if done in the traditional manner, requires at least two to three weeks of hospitalization and a prolonged period of recovery.  I went home on the fifth day, already starting to eat on my own, and continued to add foods daily, in conjunction with a feeding tube for a short while.  After that I was able to eat on my own, starting with thick liquids and soft foods, and after one month I continue to progress toward a “regular” daily life.  Dr. Chiasson is not only a highly skilled surgeon who is on the cutting edge of technology, but is also a wonderful, caring, and encouraging human being.  Not once has he treated me as a “case” or indicated that I am too ill to continue my life.  He has given me permission to eat whatever I feel ready to eat, and do whatever I feel ready to do.  He has shown much needed confidence that my wife and I have the intelligence to adequately take care of my needs during convalescence while living as full a life as possible.  My wife and I will forever be grateful.”  Bob F.