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CENTER OF EXCELLENCE

BARRETT’S ESOPHAGUS INSTITUTE

at Florida Digestive Health Specialists
  • What is Barrett’s Esophagus?

    “Barrett’s Esophagus is two to three times more likely to become cancerous than a pre-cancerous colon polyp that is not removed. Patients (and many physicians) often don’t realize the threat this disease presents.”

    Dr. Scott Corbett, board-certified Gastroenterologist with a specialty in Barrett’s Esophagus.


    • Barrett’s esophagus is a condition in which the lining of the esophagus changes to lining similar to that of the small intestine. In some patients, such modification is precancerous and carries an increased risk of developing esophageal cancer.
    • The primary cause for Barrett’s esophagus is chronic inflammation resulting from Gastroesophageal Reflux Disease (GERD). Barrett’s esophagus is more common in people who have had GERD for a long period of time or who developed it at a young age.
    • It is estimated that approximately 3 million people in the U.S. have Barrett’s esophagus.
    • GERD affects an estimated 25-35% of the U.S. population
    • 10-20% of patients with chronic GERD symptoms have Barrett’s esophagus
    • 82% of people with esophageal cancer die within 5 years of their diagnosis
    • Most patients with Barrett’s esophagus will not develop cancer. Approximately 8% of patients with Barrett’s esophagus will develop esophageal adenocarcinoma. 92% die from other causes.
    • Barrett’s esophagus diagnoses are usually made through an endoscopy procedure, which can help detect a change in the lining of the esophagus through a tissue biopsy
  • What is dysplasia?

    “Barrett’s is a protective mechanism gone bad. Barrett cells are actually more tolerant of acid, and when they form on a person’s esophagus, their symptoms will often improve, giving a false sense of security. But it is the genetic changes in these cells that allowed them to form that ultimately predispose a person to cancer.”

    Dr. Scott Corbett, board-certified Gastroenterologist with a specialty in Barrett’s Esophagus.


    • Dysplasia describes the progression of precancerous changes in the cells. Dysplasia levels indicate the extensiveness of these changes. The higher the stage of dysplasia, the higher the risk that Barrett’s esophagus will become esophageal cancer.
    • Non-dysplastic Barrett’s esophagus indicates the first change in cancer sequence. Non-dysplastic Barrett’s is still considered pre-cancerous, as this tissue may carry several pre-cancerous genetic changes prior to the development of overt dysplasia.
    • The average patient with non-dysplastic Barrett’s has a risk of developing cancer at a rate of 0.5% per patient per year, or 1/200 every year. That indicates that there is a 5% risk in 10 years, and a 10% risk over 20 years.
    • Several factors influence the above risk and may cause it to be greater or less. These include, but are not limited to: Caucasian race, male gender, age over 50, Barrett’s segment 3cm or more (with risk increasing for every cm over 3cm), having any circumferential Barrett’s, obesity (with risk 1.5x for BMI over 30), family history of Barrett’s or esophageal cancer, presence of a hiatal hernia, smoking history  and disease duration over 10 years. The presence of dysplasia substantially increases risk.
    • “No Dysplasia” means the Barrett’s esophagus cells show no precancerous changes.
    • “Low-Grade Dysplasia” means the cells show early characteristics of cancer.
    • “High-Grade Dysplasia” means that the cells show more advanced changes toward cancer.
    • “Intramucosal cancer” means cancer confined to just the thin surface layer without invading the deeper tissue layers.
    • “Invasive cancer” refers to cancer cells having invaded into the deeper tissue layers and beyond the stage that is considered curative by endoscopic methods alone.
  • What treatment is available?

    “We now have several minimally invasive methods documented in a multitude of peer reviewed studies for treating Barrett’s by removing the pre-cancerous tissue and minimizing the risk of esophageal cancer safely and effectively with cost-effectiveness and durability. Watching this through endoscopic surveillance is no longer our only option.”

    Dr. Scott Corbett, board-certified Gastroenterologist with a specialty in Barrett’s Esophagus.


    Radiofrequency Ablation (RFA)

    • Radiofrequency Ablation (RFA) is an FDA-approved, minimally invasive procedure that uses heat to destroy precancerous tissue in the esophagus.
    • RFA was first approved by the FDA to treat Barrett’s esophagus in 2001 and numerous clinical studies support its effectiveness for treating the disease. It is generally performed on an outpatient basis with the patient under moderate sedation.
    • FDHS gastroenterologists have performed thousands of RFA procedures.
    • The patient will be asked not to eat or drink anything after midnight the night before the procedure, except for small sips to take daily medication (please talk to your gastroenterologist about specific instructions).
    • Generally, RFA procedures take about 30 minutes and patients are discharged after 30 minutes of monitoring in the post-operation area. A prescribed oral pain medication and/or an oral numbing solution may be used for several days following the treatment.
    • Most patients return back to normal activities the day after the procedure, with a modified diet to allow time for healing.
    • For most patients, one to three RFA treatment sessions are needed to remove all traces of cancerous cells. The longer the Barrett’s segment, the more sessions are typically needed to remove all the tissue at risk for cancer. A follow-up endoscopy a few months later is necessary to check on the healing process and determine if additional treatment is needed.
    • Regular surveillance endoscopies are recommended for all Barrett’s patients. Your gastroenterologist will determine frequency.

    Endoscopic mucosal resection (EMR)

    • Endoscopic mucosal resection (EMR) may be needed for raised or focal defects to be determined by the endoscopist.
    • Raised and nodular areas are usually too thick to be amenable to RFA alone. EMR goes more deeply into the tissue and may more reliably remove dysplasia and early cancer, but at the cost of incurring more scar tissue and risks of bleeding and strictures.

    Cryo-balloon ablation

    • Cryo-balloon ablation is an emerging method using tissue freezing instead of heat. It may cause less discomfort and penetrate more deeply. APC (argon plasma cautery) has also been tested. Neither of these methods has been studied as extensively as RFA or EMR.

    Photo-dynamic therapy

    • PDT (photo-dynamic therapy) is an older, laser-based method now reserved mainly for palliation of more advanced disease not responding to chemotherapy or radiation in non-surgical candidates. It may result in significant scar tissue that is difficult to treat.

    Eradication of non-dysplastic Barrett’s has been shown to be over 98% effective with a recurrence rate of only 8% at 5 years, 100% of which has been amenable to touch-up. 

    Regular surveillance endoscopies are recommended for all Barrett’s patients. Your gastroenterologist will determine frequency.

     

  • FAQs

    “People don’t need to die from this disease.”

    Dr. Scott Corbett, board-certified Gastroenterologist with a specialty in Barrett’s Esophagus.


    Am I at risk for esophageal cancer?
    What is Barrett’s Esophagus?
    Who should be screened for Barrett’s Esophagus?
    What are the risk factors?
    What are the symptoms?
    How does my doctor test for Barrett’s esophagus?
    What if I have acid reflux, but test negative for Barrett’s esophagus?
    What if I don’t have any symptoms, but I have other risk factors?
  • Studies & News

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Studies & News

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