Barrett's Esophagus

Diagnosis

Historically, precancerous changes (dysplasia) in Barrett's have been challenging to diagnose. In part, this is because it can be difficult to distinguish normal from precancerous or cancerous tissue using standard endoscopy methods. Complicating matters further is the tendency of dysplasia and cancer to develop sporadically throughout the segment of Barrett's disease. In the past, doctors evaluated Barrett's by taking random tissue samples (biopsies), an approach that may miss some diseased areas.

Because knowing the exact type and location of all abnormal tissue is critical to determining the most appropriate treatment options for each patient, Mayo Clinic physicians use advanced optical and endoscopic imaging techniques that overcome the drawbacks of traditional methods. These modalities can detect minute tissue changes throughout the esophagus — sometimes without the need for biopsies — ensuring that problems are discovered in the earliest stages when they are most treatable.

High resolution endoscopy

Until recently, Barrett's esophagus was diagnosed using a standard endoscope, a lighted, flexible tube that helps doctors visually examine the esophagus and remove small, random tissue samples (biopsies) for further study. But newer electronic endoscopes with high-resolution microchips greatly improve visualization, allowing your doctor to see very small precancerous lesions and to distinguish them from other problems. Mayo Clinic physicians often combine high-resolution endoscopy with narrow-band imaging or other optical techniques that use the reflective properties of light to enhance certain characteristics of lesions in the esophagus. Studies at Mayo Clinic have shown that high-resolution endoscopy with narrow-band imaging can detect significantly more cases of advanced dysplasia — using fewer biopsy samples — than standard endoscopy can.

Endoscopic ultrasound

Mayo Clinic physicians have offered this procedure for nearly two decades and perform more than 3,000 endoscopic ultrasounds every year. During the test, a tiny ultrasound probe is placed into your esophagus through an endoscope. The probe produces sound waves that show how deeply cancer or precancerous tissue extends into the esophagus lining. EUS can be technically demanding, and produces the best results when performed by an experienced endoscopist.

Probe-based confocal microscopy

In the United States, Mayo Clinic led the way in testing probe-based confocal microscopy. Mayo physicians now use this optical imaging technology in clinical practice to detect precancerous conditions in the esophagus. Probe-based confocal microscopy uses a fiber-optic probe that is passed into your esophagus through an endoscope. Essentially a miniature microscope, the probe magnifies tissue 400 times, showing the structure of individual cells and even the nuclei within cells so clearly that tissue samples aren't needed. This allows your doctor to make a diagnosis during the exam itself, instead of waiting two or three days for biopsy results.

Near-infrared Raman Spectroscopy, Fluorescence and Reflectance Spectroscopy

Mayo Clinic is one of the few places in the world with a Raman spectroscopy probe that can be used through an endoscope. Currently being tested by Mayo Clinic physicians, this device collects a form of light originating from the lining of Barrett's esophagus tissue. The light provides a wealth of information about the molecular make-up of esophageal cells safely and quickly, without the need for tissue samples. The hope is that this and similar spectroscopy techniques will eventually replace biopsies. Mayo Clinic is also developing molecular probes for use in the esophagus. These probes will allow endoscopists to detect areas of potential cancer even before the cells undergo any changes.

Near-infrared Raman spectroscopy collects light emanating from areas of Barrett's esophagus

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Endoscopic mucosal resection (EMR)

Mayo Clinic was one of the first institutions in the United States to use endoscopic mucosal resection to diagnose and treat Barrett's esophagus and early esophageal cancer. During EMR, a saline solution is injected beneath abnormal tissue in the esophagus. The solution forms a blister that allows doctors to cut or suction away diseased tissue, while leaving the rest of the esophagus intact. It may take several visits to remove all the abnormal cells, but patients who undergo this procedure at Mayo Clinic have the same results as people who undergo surgery to remove the entire esophagus. Mayo Clinic physicians have performed more endoscopic mucosal resections than doctors at any other U.S. medical center and have among the lowest complication rates in the world.