Barrett's Esophagus

Treatment

At Mayo Clinic, treatment for Barrett's esophagus usually begins with measures to control gastroesophageal reflux disease. Your doctor may prescribe acid-blocking medications and recommend certain lifestyle changes, such as eating smaller meals, stopping smoking if you smoke, avoiding foods that aggravate heartburn and elevating the head of your bed to prevent reflux during sleep. If you have a hiatal hernia, a common cause of acid reflux, your doctor is likely to recommend surgery to repair it before you undergo other treatments.

After taking these steps, a few people diagnosed with dysplasia may decide not to receive further care. Instead, they choose to schedule screening endoscopies every three to six months and treat cancer only if it develops. Most patients, however, seek more aggressive treatment to eliminate Barrett's esophagus completely. For these patients and for those with early esophageal cancer, Mayo Clinic offers an array of minimally invasive and surgical treatment options. Mayo physicians thoroughly explain the benefits and risks of each treatment and take time to answer all of your questions so that you can make the most informed decision possible. In many cases, therapies can be tailored to meet your particular needs and preferences.

Minimally invasive options

In the past decade, Mayo Clinic physicians have pioneered the use of a number of innovative therapies for Barrett's esophagus and early esophageal cancer. The goal of these therapies is to destroy abnormal cells and allow healthy new cells to grow in their place while preserving the esophagus. In general, these procedures are far less risky, painful and debilitating than surgery is. But they may not be appropriate for everyone, and because three or more treatments are usually needed to achieve results, nonsurgical procedures require patience and commitment.

• Endoscopic mucosal resection (EMR): Mayo Clinic was one of the first institutions in the United States to use endoscopic mucosal resection to both diagnose and treat Barrett's esophagus and early esophageal cancer. During the procedure, a saline solution injected under the Barrett's lining forms a blister that allows doctors to cut or suction away abnormal tissue, leaving the rest of the esophagus intact. Although you may need more than one visit to remove all the abnormal cells, patients who undergo this procedure at Mayo have the same survival rates as people who undergo surgery to remove the entire esophagus. Mayo Clinic's EMR complication rates are among the lowest in the world.
• Radiofrequency ablation (RFA): Mayo Clinic physicians pioneered the use of radiofrequency ablation for both low- and high-grade dysplasia and have performed more of these procedures than doctors at any other academic medical center in the United States. RFA uses controlled bursts of radiofrequency energy to burn away thin layers of esophageal tissue. The outpatient procedure takes about 60 minutes, and you can usually return to your normal activities the next day, though you may experience some chest pain and difficulty swallowing for about a week. In clinical trials at Mayo Clinic, radiofrequency ablation completely eliminated abnormal tissue in 90 percent of patients with low-grade dysplasia and 80 percent of those with high-grade dysplasia.
• Cryotherapy: Mayo Clinic is one of a handful of institutions in the United States offering cryotherapy, which uses liquid nitrogen or carbon dioxide to freeze cancer cells in the esophagus. The frozen tissue thaws and ultimately sloughs off, allowing healthy, new tissue to grow in its place. Depending on the extent of disease and your response to treatment, sessions are repeated every two to six weeks. Most people need at least three sessions to remove all the abnormal tissue.
• Photodynamic Therapy (PDT): Mayo Clinic physicians were the first to use photodynamic therapy in humans in the 1960s, and Mayo Clinic remains a leader in researching and using this treatment. You are first given an intravenous drug called porfimer sodium (Photofrin) that makes Barrett's cells sensitive to light. A few days later, your doctor activates the drug inside your esophagus with a laser light inserted through an endoscope. The interaction between light and the drug create energy that's transmitted to surrounding tissue, killing the targeted cells. Photodynamic therapy can also be used to treat cancer that recurs after surgery or in conjunction with endoscopic mucosal resection. It produces the deepest tissue destruction of any ablative method, but also carries a higher risk of complications.

Surgery

Long considered the standard of care for early esophageal cancer, surgery to remove the esophagus (esophagectomy) is sometimes also used to treat high-grade dysplasia. Removing the esophagus eliminates dysplasia or cancer, and the likelihood that either will recur is low. Mayo Clinic is one of the world's largest and most experienced medical centers for esophageal surgery, performing more than 150 esophagectomies every year. During the procedure, surgeons remove the damaged portion of the esophagus and sometimes nearby lymph nodes and the upper part of the stomach. To re-establish the continuity of the digestive tract, the stomach is formed into a tube and pulled upward to join the remaining portion of the esophagus. Surgery for esophageal disorders is complex and carries risks that include infection, bleeding and leakage from the area where the remaining esophagus is reattached. Hospitals whose surgeons are experienced in performing esophagectomies have significantly lower mortality and complication rates than hospitals where few esophagectomies are performed.

When possible, Mayo Clinic surgeons perform esophageal surgery using laparoscopic techniques. Unlike traditional open surgery, which requires long abdominal and chest or neck incisions, minimally invasive esophagectomy uses four or five small incisions that require just a stitch or two to close. This approach causes less trauma to the body, and usually leads to shorter hospital stays, reduced postoperative pain and a faster recovery. Minimally invasive esophagectomy is a complex surgery, but it can produce excellent results in the hands of a skilled surgeon. Mayo Clinic has one of the largest and most experienced minimally invasive surgery practices in the United States, performing thousands of procedures every year.

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