Barrett's esophagus is a precancerous condition that arises in the lining of the esophagus.
Patients with gastroesophageal reflux disease or GERD are at increased risk for the development of Barrett's and the most common cancer of the esophagus called adenocarcinoma.
We believe the care of patient's Barrett's Esophagus must be individualized. At Fox Chase, our philosophy is to provide compassionate care based on a thorough, personalized assessment of the patient's condition, taking into account the patient's overall medical history, his or her individual priority and needs, and a careful analysis of biopsy material.
The Best Care:
Treatment Options for Barrett's Esophagus
Until recently, the best way to care for patients with Barrett's esophagus without cancer was to simply monitor patients with periodic endoscopy. Once cancer was detected, or more worrisome changes suggesting a progression to cancer were seen, the patient was referred for surgery. However, we now have at our disposal at Fox Chase some very useful treatments via the endoscope. These valuable treatments can, in many cases, prevent the need for surgery and the development of cancer.
Radiofrequency Ablation (RFA) This technique uses a special catheter inserted through a standard endoscope, which generates energy to cauterize and eradicate the Barrett's cells. Research studies have shown that this technique is safe and effective in the vast majority of cases in eliminating Barrett's tissue with dysplastic (precancerous) cells.
Cryotherapy In this procedure, the physician applies liquid nitrogen spray through the endoscope to eliminate Barrett's tissue. Like radiofrequency ablation, this technique appears to be quite effective in eradicating Barrett's cells. Fox Chase is one of the few centers in the Delaware Valley that can offer this treatment. Cryotherapy appears to be safe and effective not only in eliminating dysplastic Barrett's tissue; we also use this technique in some patients with cancer of the esophagus to reduce the size of esophageal tumors and improve patients' ability to swallow.
Endoscopic Ultrasound For patients with Barrett's esophagus and nodules, or some early cancer in Barrett's, we perform perform upper endoscopy with endoscopic ultrasound to assess the thickness of the nodule or lymph node involvement. This helps guide our approach to treatment.
Endoscopic Mucosal Resection For patients with Barrett's esophagus with localized precancerous nodules, or some very early cancers, the best treatment is endoscopic mucosal resection (EMR). In this procedure, the physician performs an endoscopy and mechanically removes the abnormal nodular tissue using specialized accessories designed expressly for this purpose. Unlike RFA and cryotherapy, EMR provides tissue for biopsy. At Fox Chase, our highly trained and experienced physicians are skilled in this advanced endoscopic technique.
Surgery Even with the wide variety of advanced endoscopic techniques available, surgery is still the best option for some patients. Our highly skilled thoracic surgeons specialize in cancer surgery, and are trained in state-of-the-art surgical techniques including minimally invasive esophageal surgery. Our volume of esophageal surgery at Fox Chase is among the highest in the Delaware Valley.
Fox Chase has an active research program to improve assessment of risk for cancer development in Barrett’s. Patients are offered the option of enrolling in this program, which examines additional biopsies using advanced molecular methods. Call the Barrett's Program at 215-214-1460.
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