How do doctors treat Barrett’s esophagus?
Your doctor will talk about the best treatment options for you based on your overall health, whether you have dysplasia, and its severity. Treatment options include medicines for GERD, endoscopic ablative therapies, endoscopic mucosal resection, and surgery.
Periodic surveillance endoscopy
Your doctor may use upper gastrointestinal endoscopy with a biopsy periodically to watch for signs of cancer development. Doctors call this approach surveillance.
Experts aren’t sure how often doctors should perform surveillance endoscopies. Talk with your doctor about what level of surveillance is best for you. Your doctor may recommend endoscopies more frequently if you have high-grade dysplasia rather than low-grade or no dysplasia. Read whether people with Barrett’s esophagus are more likely to develop cancer.
Medicines
If you have Barrett’s esophagus and gastroesophageal reflux disease (GERD), your doctor will treat you with acid-suppressing medicines called proton pump inhibitors (PPIs). These medicines can prevent further damage to your esophagus and, in some cases, heal existing damage.
PPIs include
- omeprazole (Prilosec, Zegerid)
- lansoprazole (Prevacid)
- pantoprazole (Protonix)
- rabeprazole (AcipHex)
- esomeprazole (Nexium)
- dexlansoprazole (Dexilant)
All of these medicines are available by prescription. Omeprazole and lansoprazole are also available in over-the-counter strength.
Your doctor may consider anti-reflux surgery if you have GERD symptoms and don’t respond to medicines. However, research has not shown that medicines or surgery for GERD and Barrett’s esophagus lower your chances of developing dysplasia or esophageal adenocarcinoma.
Endoscopic ablative therapies
Endoscopic ablative therapies use different techniques to destroy the dysplasia in your esophagus. After the therapies, your body should begin making normal esophageal cells.
A doctor, usually a gastroenterologist or surgeon, performs these procedures at certain hospitals and outpatient centers. You will receive local anesthesia and a sedative. The most common procedures are the following:
- Photodynamic therapy. Photodynamic therapy uses a light-activated chemical called porfimer (Photofrin), an endoscope, and a laser to kill precancerous cells in your esophagus. A doctor injects porfimer into a vein in your arm, and you return 24 to 72 hours later to complete the procedure.
- Radiofrequency ablation. Radiofrequency ablation uses radio waves to kill precancerous and cancerous cells in the Barrett’s tissue. An electrode mounted on a balloon or an endoscope creates heat to destroy the Barrett’s tissue and precancerous and cancerous cells.
Endoscopic mucosal resection
In endoscopic mucosal resection, your doctor lifts the Barrett’s tissue, injects a solution underneath or applies suction to the tissue, and then cuts the tissue off. The doctor then removes the tissue with an endoscope. Gastroenterologists perform this procedure at certain hospitals and outpatient centers. You will receive local anesthesia to numb your throat and a sedative to help you relax and stay comfortable.
Before performing an endoscopic mucosal resection for cancer, your doctor will do an endoscopic ultrasound.
Complications can include bleeding or tearing of your esophagus. Doctors sometimes combine endoscopic mucosal resection with photodynamic therapy.
Surgery
Surgery called esophagectomy is an alternative to endoscopic therapies. Many doctors prefer endoscopic therapies because these procedures have fewer complications.
Esophagectomy is the surgical removal of the affected sections of your esophagus. After removing sections of your esophagus, a surgeon rebuilds your esophagus from part of your stomach or large intestine. The surgery is performed at a hospital. You’ll receive general anesthesia, and you’ll stay in the hospital for 7 to 14 days after the surgery to recover.
Surgery may not be an option if you have other medical problems. Your doctor may consider the less-invasive endoscopic treatments or continued frequent surveillance instead.
