Barrett’s esophagus is a condition characterized by the transformation of the normal lining of the lower esophagus into tissue resembling that of the intestines. This change is primarily triggered by chronic gastroesophageal reflux disease (GERD), where stomach acid frequently washes back into the esophagus, causing irritation and cellular changes over time. Barrett’s esophagus is a concerning condition because it is considered a precursor to esophageal adenocarcinoma, a type of cancer with poor prognosis. Endoscopic management has emerged as a critical approach to monitoring and treating this condition, aiming to prevent its progression to cancer.
Barrett’s Esophagus and Its Significance: Barrett’s esophagus is a response of the esophageal tissue to the chronic exposure to stomach acid. This prolonged irritation prompts the normal squamous cells of the esophagus to transform into columnar cells resembling those found in the intestines. This process, known as intestinal metaplasia, is a protective mechanism, but it also increases the risk of cancer development. Patients with Barrett’s esophagus are at a higher risk of developing esophageal adenocarcinoma, a malignancy with a poor prognosis due to late-stage diagnosis.
Endoscopic Management of Barrett’s Esophagus: Endoscopic techniques play a pivotal role in the management of Barrett’s esophagus by enabling close surveillance and targeted treatments to prevent cancer progression.
- Endoscopic Surveillance: Regular endoscopic surveillance with a procedure called esophagogastroduodenoscopy (EGD) is recommended for patients with Barrett’s esophagus. During EGD, a flexible tube with a camera is inserted through the mouth and into the esophagus. The endoscopist examines the esophageal lining for any signs of dysplasia (abnormal cellular changes) or early cancer. The frequency of surveillance depends on the extent of Barrett’s esophagus and the presence of dysplasia.
- Endoscopic Mucosal Resection (EMR): If dysplasia or early cancer is detected, endoscopic mucosal resection may be performed. EMR involves removing the abnormal tissue through an endoscope, allowing for pathological examination and accurate staging. This technique is particularly useful for localized lesions, where surgical removal may not be necessary.
- Radiofrequency Ablation (RFA): RFA is a technique that uses controlled heat to destroy the abnormal cells in the esophageal lining. This procedure aims to induce a healing response, replacing the abnormal tissue with healthy squamous cells. RFA can be effective in eliminating dysplasia and preventing its progression to cancer.
- Cryotherapy: Cryotherapy involves freezing and destroying the abnormal cells using extreme cold. This technique can also be used to target and remove the precancerous tissue in Barrett’s esophagus.
- Endoscopic Submucosal Dissection (ESD): ESD is a more advanced technique that allows for en-bloc resection of larger lesions, providing a better specimen for pathological evaluation. Dr. Fasullo was trained to perform ESD by world-renowned physician, Dr. Gregory Haber, while training at NYU.