Barrett's Esophagus

Diagnosis

GERD patients with severe reflux should be tested for Barrett's esophagus. Diagnosis of the condition usually requires taking a sample of tissue by endoscopy. Doctors insert a lighted, flexible tube (endoscope) with a camera on its tip through the mouth and into the esophagus. Patients are given a local anesthetic or sedated for the procedure. During endoscopy, doctors may remove tissue samples (biopsies) of potentially abnormal areas for examination under a microscope.

Patients who are diagnosed with Barrett's esophagus should regularly undergo endoscopic examination and biopsy to detect precancerous changes (dysplasia) at an early and curable stage. Physicians at Mayo Clinic follow the guidelines of the American College of Gastroenterology, which are as follows:

• Barrett's esophagus without dysplasia (cancerous changes) — If, at the first endoscopy all biopsies are without dysplasia, a second examination is recommended in one year. This is done to make sure that a very small cancer (also known as a prevalent cancer) was not missed at the first endoscopy. For those without dysplasia at the second examination, follow-up endoscopy is recommended in three to five years.
• Barrett's esophagus with low-grade dysplasia — follow-up endoscopy is recommended every six months for a year, than every 12 months. Low grade dysplasia, by itself, is usually not lethal. Follow up is to make sure a serious finding is not missed.
• Barrett's esophagus with high-grade dysplasia — If two pathologists agree that biopsies show high grade dysplasia, then intervention is usually suggested. The standard of care treatment is esophagus resection surgery or minimally invasive treatment such as photodynamic therapy. In cases where the high grade dysplasia is only found in one small bump, an experimental option, endoscopic mucosal resection, may be possible. If a patient is not a good candidate for surgery, the doctor may opt to increase acid suppression medications and repeat an endoscopic examination in three months.

Diagnostic Techniques

The techniques listed below are used to determine with utmost accuracy which patients are best treated with PDT and which patients should consider surgery or other treatments.

Endoscopic Ultrasound

This procedure is used to determine if the cancer or precancerous tissue involves only the very top layer of cells and is therefore an intramucosal cancer.

Endoscopic Mucosal Resection (EMR)

This experimental procedure is used to remove a suspicious area of high-grade dysplasia. It is performed through an endoscope; it involves lifting up the Barrett's lining, injecting a solution under it or applying suction and then cutting it off.

Fine Needle Aspiration

A needle is used to sample the para-esophageal lymph nodes to look for evidence of spread of cancer.