1. Heartburn Slideshow: Foods to Eat, Foods to Avoid
2. Digestive Myths Slideshow: Common Misconceptions
3. GERD Quiz: Test Your Digestive Diseases IQ

Medical Author:

Bhupinder Anand, MD

Medical Author:

Wilfred M. Weinstein, MD

Medical Editor:

Jay W. Marks, MD

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

View Full Profile

In this Article

• What is Barrett's esophagus?
• Why is there so much interest in Barrett's esophagus?
• What causes Barrett's esophagus?
• Who develops Barrett's esophagus?
• What is the specific abnormality in the inner lining (epithelium) of Barrett's esophagus?
• What about the cancer that occurs in Barrett's esophagus?
• What is dysplasia in Barrett's esophagus?
• What is the risk of developing adenocarcinoma of the esophagus in Barrett's?
• What are the symptoms of Barrett's esophagus?
• How is GERD with or without Barrett's esophagus treated?
• Why is it important to screen patients with GERD to diagnose Barrett's esophagus?
• Why is it critical to be accurate in the diagnosis of Barrett's esophagus?
• What does endoscopic biopsy surveillance in Barrett's esophagus involve?
• How is high grade dysplasia managed?
• How is low grade dysplasia managed?
• What are the experimental approaches for treatment of high grade dysplasia?
• What experimental options are there for Barrett's esophagus WITHOUT dysplasia?
• What does the future hold for Barrett's esophagus?
• Barrett's Esophagus At A Glance
• GERD (Gastroesophageal Reflux Disease) FAQs
• Patient Comments: Barrett&39;s Esophagus - Experience
• Patient Comments: Barrett&39;s Esophagus - Symptoms and Signs
• Find a local Gastroenterologist in your town
• Barrett's Esophagus Index

The most common standard by which treatments for cancer or related disorders, such as dysplasia, are measured is by the 5-year outcome. For example, we just mentioned the 80% five year survival rate for esophageal cancers that were found by surveillance in Barrett's and then treated by esophagectomy (surgical removal of the esophagus).

The finding of high grade dysplasia in Barrett's may mean that cancer already is present. For this reason, when high grade dysplasia is found, the next step is to repeat the endoscopy and take more biopsies. For this purpose, the recommendation is to take four biopsies (one from each quadrant) every one centimeter rather than every two centimeters. If the biopsy findings again reveal just high grade dysplasia, there are a number of management options, including esophagectomy, continued biopsy surveillance, and experimental approaches.

Endoscopic ultrasound

Endoscopic ultrasound is invaluable in the staging of early cancers to determine the depth of their penetration into surrounding tissue. It also can be used to determine if dysplastic tissue has invaded the surrounding tissue, that is, has become cancerous. This technique uses endoscopes as dedicated ultrasound devices. In other words, these endoscopes are used only for doing endoscopic ultrasound. These instruments can literally see through the wall of the esophagus with much greater accuracy than, for example, a computerized tomographic (CT) scan. Endoscopic ultrasound is available in most centers that specialize in Barrett's esophagus and/or esophageal cancer.

Esophagectomy

The gold standard for the management of high grade dysplasia is esophagectomy. Esophagectomy involves total removal of the esophagus except for a very short cuff of esophagus at its upper end. The esophagus is replaced with a segment of colon, or stomach is brought up under the breastbone and attached to the remaining cuff of the esophagus. Patients with Barrett's awaiting an esophagectomy should seek an experienced surgeon with a good track record. They should interview the surgeon about his/her results. There is no validated or magic annual number of operations that provides enough surgical experience, but some surgeons believe it should be at least 20 per year. What's important is not just the experience with the actual surgery, but also the experience of the team involved in the pre and post operative care.

The operative death rate (mortality) associated with esophagectomy for high grade dysplasia and early cancer is near 0%. However, in the postoperative period, a host of complications (operative morbidity) may occur, most of which are transient (self-limited). These complications may include delayed gastric emptying of food, temporary hoarseness, and strictures of the esophagus (narrowed areas caused by scarring).

Follow-up biopsy surveillance, and esophagectomy ONLY if cancer is found

Some patients with high grade dysplasia opt to have a close follow-up. In these individuals, endoscopic biopsy surveillance is done initially every three months for at least a year and then less often (for exmple, every four to six months). The understanding is that surgery (esophagectomy) will be done if carcinoma were found during the course of the follow-up. This has not been a universally popular approach except at a few centers. It requires a commitment on the part of the endoscopist to do meticulous surveillance biopsies frequently. It also requires that the patient be reconciled with the frequent follow-up procedures and with the attendant uncertainty for what the future holds.