Endoscopic Procedures for Barrett’s Esophagus
NYU Langone doctors may recommend endoscopic therapies to treat dysplastic, or precancerous, tissue in people with moderate to severe Barrett’s esophagus. These procedures may include ablative therapies, in which damaged tissue is frozen or heated; photodynamic therapy, in which laser light destroys the tissue; or endoscopic resection, which involves removing the affected tissue.
At NYU Langone, a gastroenterologist or surgeon performs these procedures using an endoscope—a flexible tube with a camera at its tip—that is passed through the nose or mouth and into the esophagus. Your doctor gives you a sedative to ensure that you’re comfortable during the procedure, and most people are able to go home soon after the sedative wears off.
If gastroesophageal reflux disease, or GERD, is caused by a hiatal hernia—in which the upper part of the stomach protrudes upward and into the chest—your surgeon may discuss whether a procedure to treat it may help you. Sometimes doctors recommend more than one procedure for people with GERD and Barrett’s esophagus. They make this decision based on the results of diagnostic tests.
In cryotherapy ablation, extreme cold is used to destroy damaged tissue in the esophagus. During this procedure, the doctor sprays liquid nitrogen onto abnormal cells, causing them to freeze and die. Healthy cells grow in place of the destroyed tissue. The doctor may need to repeat this procedure every few weeks until the precancerous cells are completely destroyed.
Most people can return home after the sedative wears off. You may experience minor pain and swelling for a few days in the area where the liquid nitrogen was applied.
Radiofrequency ablation uses high-energy radio waves to destroy precancerous cells. During this procedure, an electrode that generates heat is positioned on the end of an endoscope or a catheter, a slim, flexible tube. The doctor places the electrode on the surface of the dysplastic tissue and heat from radio waves destroys the tissue. Over the next several weeks, healthy cells grow in their place.
You may experience mild pain and swelling in the esophagus for a few days after the procedure.
Photodynamic therapy uses a laser—a highly focused form of light—to destroy precancerous cells in the esophagus.
One to three days before the procedure, your doctor gives you a light-activated medication called porfimer. After it is injected into a vein, the chemical circulates in the body for the next couple of days. When exposed to light, the medication produces a form of oxygen that destroys nearby cells.
On the day of the procedure, the doctor places an endoscope in the esophagus to apply laser light to the affected area, thereby destroying the damaged tissue.
The procedure can cause swelling in the esophagus for a few days, which may interfere with swallowing. Because porfimer can cause the skin and eyes to become more sensitive to light, your doctor may recommend avoiding direct sunlight for several weeks after the procedure.
Endoscopic Mucosal Resection
Endoscopic mucosal resection is a minimally invasive surgical procedure used to remove abnormal, precancerous tissue from the lining of the esophagus.
During the procedure, your doctor uses a needle inserted through the endoscope to inject a liquid solution containing saline, contrast dye, and sometimes medicine to reduce bleeding under abnormal esophageal tissue. The liquid lifts and separates the abnormal tissue from the normal tissue. The surgeon uses small instruments to remove, or resect, the abnormal area, and the tissue is sent to a laboratory for analysis. Results are usually available within one week.
Side effects include discomfort in the back of the throat for a few days after the procedure. Doctors recommend a liquid diet for 24 to 48 hours. Complications can include bleeding in or tearing of the esophagus.
Endoscopic Submucosal Dissection
If diagnostic tests indicate that the area of precancerous cells is too large to be removed using endoscopic mucosal resection, your doctor may recommend endoscopic submucosal dissection.
In this procedure, which requires general anesthesia, the doctor injects a liquid solution through an endoscope. It’s placed beneath the abnormal tissue, elevating the tissue and making it easier for doctors to remove. If there are high-grade dysplastic cells in the esophageal lining, doctors may remove additional tissue from the submucosal layer, which is located beneath the mucosal layer. This may prevent cancer if the abnormal cells are limited to the mucosal layer.
After surgery, small tissue samples may be sent to a laboratory for examination under a microscope. This can help doctors determine the extent of precancerous tissue and the likelihood that it may spread and become cancerous.
If Barrett’s esophagus progresses to invasive esophageal cancer, your surgeon may explore other surgical options, such as partial or total esophagectomy, in which some or all of the esophagus is removed.