Our gastroenterology department is home to the largest volume of Barrett’s esophagus patients in the region, made up of the most experienced team. In fact, we were the first in the area to offer radiofrequency ablation (RFA) and perform more RFA procedures today than any other area hospital. We were also the first regional site to utilize cryoablation for advanced Barrett’s esophagus, including palliation of esophageal cancer.
Because esophageal cancer has few early warning signs, our experts recommend a screening endoscopy—a minimally invasive test that looks at your upper digestive tract—for all patients with severe gastroesophageal reflux disease (GERD), to look for this precancerous condition. If Barrett’s or early esophageal cancer is detected, we offer the most up-to-date endoscopic techniques and technology for diagnosis and treatment, including access to clinical trials as appropriate.
What is Barrett’s esophagus?
Many people suffer from gastrointestinal problems, with acid reflux and heartburn topping the list. Not only can frequent flare-ups cause real discomfort, but they can also be the sign of Barrett’s esophagus.
Barrett's esophagus occurs when the sensitive lining of the esophagus—the tube that carries food from the throat to the stomach—is damaged by strong stomach acid repeatedly leaking back up into the food pipe. Up to 15 percent of people with GERD will develop Barrett’s esophagus but, without an endoscopy, most will never know it. That is because Barrett’s has no definitive symptoms in its early stages, when detection is most helpful. Rather, people with the condition often describe it as routine heartburn.
Sometimes, Barrett’s rogue cells continue to mutate, eventually turning into dysplasia—a precursor to esophageal adenocarcinoma (cancer). But with early detection, diligent monitoring, and appropriate interventions, those mutant cells can often be transformed back to normal, stopping the development of cancer for the majority of Barrett’s patients.
About esophageal cancer
Esophageal cancer is rare, with only about 17,000 new cases predicted annually. However, it is often deadly, in part because its main symptoms—painful or difficult swallowing, unexplained weight loss, hoarseness, cough, and indigestion—mostly appear only when the disease is advanced. While there are several causes of esophageal cancer, acid reflux leading to Barrett’s esophagus is the predominant risk factor. Men are four times more likely to develop the disease, which is usually diagnosed at age 50 and older.
Tests and treatments for Barrett's esophagus
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Radiofrequency ablation (RFA) :
RFA uses heat to destroy precancerous cells, effectively preventing Barrett’s esophagus from developing into cancer. It is most effective against advanced dysplasia and/or when precancerous cells cover a large portion of the esophagus. Treatment typically takes three, 30-minute outpatient sessions, performed under general anesthesia. The procedure is repeated every 3 months to allow the esophagus to heal between sessions. Most patients are able to return to their normal lifestyle the day after the procedure. -
Cryoablation therapy:
This innovative approach uses extreme cold to freeze and kill cancers of the gastrointestinal tract. Cryoablation can penetrate tissues more deeply than RFA, making it especially valuable for recurrent esophageal cancers and Barrett’s’ esophagus with abnormal or pre-cancerous cells. -
Endoscopic ultrasound :
A minimally invasive diagnostic study used to examine surrounding lymph nodes in certain cases for better staging of advanced Barrett’s esophagus and cancer. -
Endoscopic mucosal resection (EMR) :
This versatile procedure can help with staging, treatment decisions, and in some situations, even remove Barrett’s cells or early esophageal cancer, preventing surgery altogether. EMR is especially important in patients who have advanced, yet potentially curable, disease. By measuring tissue depth, the procedure can determine how far the cancer has penetrated for improved staging. Endoscopic mucosal resection also allows doctors to determine whether the disease is treatable by minimally invasive endoscopic procedures or will need surgery, chemotherapy, radiation, or some combination thereof. -
Clinical trials :
As an academic medical center and part of the Georgetown Lombardi Comprehensive Cancer Center—the area’s only NCI comprehensive cancer center—the physicians/scientists at MedStar Health actively pursue research studies to advance basic knowledge and, ultimately, improve care. From time to time, patients may be eligible for clinical trials, often gaining access to potential new therapies before others. To see what's currently available and to learn about eligibility criteria, please click here.
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Acid Reflux, GERD & Barrett's Esophagus: Ask Dr. John Carroll
