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Surgical Management of Benign Esophageal Disorders pp 201–214Cite as

Barrett’s Esophagus: Treatment Options and Management

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Abstract

Barrett’s esophagus (BE) involves specialized intestinal metaplasia of the esophagus and is a precursor of esophageal adenocarcinoma. Although no randomized trials have demonstrated mortality benefit, we recommend patients with multiple risk factors for BE undergo endoscopic screening for dysplasia (which should be confirmed by an expert pathologist). Patients with BE should be treated with proton pump inhibitor (PPI) and be considered for PPI even in the absence of reflux symptoms or reflux esophagitis. We recommend patients with BE with no dysplasia, low-grade dysplasia (LGD), and high-grade dysplasia (HGD) (in the absence of eradication therapy) have endoscopic surveillance. In most patients with BE-associated HGD, we recommend endoscopic eradication therapy rather than surgery or intensive surveillance. This involves endoscopic mucosal resection (EMR) for removal and staging of visible lesions (if present) followed by radiofrequency ablation or photodynamic therapy to ablate remaining metaplastic epithelium. Surgery is a reasonable alternative in young patients with HGD and long-segment BE or multifocal dysplasia, whereas intensive surveillance is reasonable in elderly and frail patients where endoscopic therapy might pose a substantial risk.

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Abbreviations

APC:

Argon plasma coagulation

BE:

Barrett’s esophagus

EAC:

Esophageal adenocarcinoma

EMR:

Endoscopic mucosal resection

ESD:

Endoscopic submucosal dissection

EUS:

Endoscopic ultrasound

GERD:

Gastroesophageal reflux disease

HGD:

High-grade dysplasia

IGD:

Indeterminate-grade dysplasia

IMC:

Intramucosal carcinoma

LGD:

Low-grade dysplasia

NDBE:

Non-dysplastic Barrett’s esophagus

PDT:

Photodynamic therapy

PPI:

Proton pump inhibitor

RFA:

Radiofrequency ablation

References

  1. Hvid-Jensen F, Pedersen L, Drewes AM, Sørensen HT, Funch-Jensen P. Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med. 2011;365(15):1375.

    Article  PubMed  CAS  Google Scholar 

  2. Bhat S, Coleman HG, Yousef F, Johnston BT, McManus DT, Gavin AT, et al. Risk of malignant progression in Barrett’s esophagus patients: results from a large population-based study. J Natl Cancer Inst. 2011;103(13):1049.

    Article  PubMed  Google Scholar 

  3. Rugge M, Fassan M, Cavallini F, Zaninotto G. Risk of malignant progression in Barrett’s esophagus patients: results from a large population-based study. J Natl Cancer Inst. 2012;104(22):1771.

    Article  PubMed  Google Scholar 

  4. Van der Veen AH, Dees J, Blankensteijn JD, Van Blankenstein M. Adenocarcinoma in Barrett’s oesophagus: an overrated risk. Gut. 1989;30(1):14.

    Article  PubMed  Google Scholar 

  5. Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ, American Gastroenterological Association. American Gastroenterological Association medical position statement on the management of Barrett’s esophagus. Gastroenterology. 2011;140(3):1084.

    Article  PubMed  Google Scholar 

  6. Corley DA, Levin TR, Habel LA, et al. Surveillance and survival in Barrett’s adenocarcinomas: a population-based study. Gastroenterology. 2002;122:633–40.

    Article  PubMed  Google Scholar 

  7. Bytzer P, Christensen PB, Damkier P, et al. Adenocarcinoma of the esophagus and Barrett’s esophagus: a population-based study. Am J Gastroenterol. 1999;94:86–91.

    Article  PubMed  CAS  Google Scholar 

  8. Rubenstein JH, Taylor JB. Meta-analysis: the association of oesophageal adenocarcinoma with symptoms of gastro-oesophageal reflux. Aliment Pharmacol Ther. 2010;32:1222–7.

    Article  PubMed  CAS  Google Scholar 

  9. Hornick JL, Odze RD. Neoplastic precursor lesions in Barrett’s esophagus. Gastroenterol Clin North Am. 2007;36:775–96.

    Article  PubMed  Google Scholar 

  10. Fitzgerald RC, Omary MB, Triadafilopoulos G. Dynamic effects of acid on Barrett’s esophagus. An ex vivo proliferation and differentiation model. J Clin Invest. 1996;98(9):2120.

    Article  PubMed  CAS  Google Scholar 

  11. Ouatu-Lascar R, Fitzgerald RC, Triadafilopoulos G. Differentiation and proliferation in Barrett’s esophagus and the effects of acid suppression. Gastroenterology. 1999;117(2):327.

    Article  PubMed  CAS  Google Scholar 

  12. Peters FT, Ganesh S, Kuipers EJ, Sluiter WJ, Klinkenberg-Knol EC, Lamers CB, et al. Endoscopic regression of Barrett’s oesophagus during omeprazole treatment; a randomised double blind study. Gut. 1999;45(4):489.

    Article  PubMed  CAS  Google Scholar 

  13. Rossi M, Barreca M, de Bortoli N, Renzi C, Santi S, Gennai A, et al. Efficacy of Nissen fundoplication versus medical therapy in the regression of low-grade dysplasia in patients with Barrett esophagus: a prospective study. Ann Surg. 2006;243(1):58.

    Article  PubMed  Google Scholar 

  14. Chang EY, Morris CD, Seltman AK, O’Rourke RW, Chan BK, Hunter JG, et al. The effect of antireflux surgery on esophageal carcinogenesis in patients with Barrett esophagus: a systematic review. Ann Surg. 2007;246(1):11.

    Article  PubMed  Google Scholar 

  15. Streitz Jr JM, Andrews Jr CW, Ellis Jr FH. Endoscopic surveillance of Barrett’s esophagus. Does it help? J Thorac Cardiovasc Surg. 1993;105:383.

    PubMed  Google Scholar 

  16. Peters JH, Clark GW, Ireland AP, et al. Outcome of adenocarcinoma arising in Barrett’s esophagus in endoscopically surveyed and nonsurveyed patients. J Thorac Cardiovasc Surg. 1994;108:813.

    PubMed  CAS  Google Scholar 

  17. Fountoulakis A, Zafirellis KD, Dolan K, et al. Effect of surveillance of Barrett’s oesophagus on the clinical outcome of oesophageal cancer. Br J Surg. 2004;91:997.

    Article  PubMed  CAS  Google Scholar 

  18. Wong T, Tian J, Nagar AB. Barrett’s surveillance identifies patients with early esophageal adenocarcinoma. Am J Med. 2010;123:462.

    Article  PubMed  Google Scholar 

  19. Sharma P, Falk GW, Weston AP, et al. Dysplasia and cancer in a large multicenter cohort of patients with Barrett’s esophagus. Clin Gastroenterol Hepatol. 2006;4:566.

    Article  PubMed  Google Scholar 

  20. Verbeek RE, van Oijen MG, ten Kate FJ, et al. Surveillance and follow-up strategies in patients with high-grade dysplasia in Barrett’s esophagus: a Dutch population-based study. Am J Gastroenterol. 2012;107:534.

    Article  PubMed  Google Scholar 

  21. Sikkema M, Looman CW, Steyerberg EW, et al. Predictors for neoplastic progression in patients with Barrett’s esophagus: a prospective cohort study. Am J Gastroenterol. 2011;106:1231.

    Article  PubMed  CAS  Google Scholar 

  22. Sikkema M, de Jonge PJ, Steyerberg EW, Kuipers EJ. Risk of esophageal adenocarcinoma and mortality in patients with Barrett’s esophagus: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2010;8:235.

    Article  PubMed  Google Scholar 

  23. Eloubeidi MA, Provenzale D. Does this patient have Barrett’s esophagus? The utility of predicting Barrett’s esophagus at the index endoscopy. Am J Gastroenterol. 1999;94:937–43.

    Article  PubMed  CAS  Google Scholar 

  24. Kim SL, Waring JP, Spechler SJ, et al. Diagnostic inconsistencies in Barrett’s esophagus. Department of Veterans Affairs Gastroesophageal Reflux Study Group. Gastroenterology. 1994;107:945–9.

    PubMed  CAS  Google Scholar 

  25. Song LMWK, Adler DG, Chand B, et al. Chromoendoscopy. Gastrointest Endosc. 2007;66:639–49.

    Article  Google Scholar 

  26. Kantsevoy SV, Adler DG, Conway JD, et al. Confocal laser endomicroscopy. Gastrointest Endosc. 2009;70:197–200.

    Article  PubMed  Google Scholar 

  27. Kara MA, Peters FP, Ten Kate FJ, et al. Endoscopic video autofluorescence imaging may improve the detection of early neoplasia in patients with Barrett’s esophagus. Gastrointest Endosc. 2005;61:679–85.

    Article  PubMed  Google Scholar 

  28. Shami VM, Villaverde A, Stearns L, et al. Clinical impact of conventional endosonography and endoscopic ultrasound-guided fine-needle aspiration in the assessment of patients with Barrett’s esophagus and high grade dysplasia or intramucosal carcinoma who have been referred for endoscopic ablation therapy. Endoscopy. 2006;38:157–61.

    Article  PubMed  CAS  Google Scholar 

  29. Moss A, Bourke MJ, Hourigan LF, et al. Endoscopic resection for Barrett’s high-grade dysplasia and early esophageal adenocarcinoma: an essential staging procedure with long-term therapeutic benefit. Am J Gastroenterol. 2010;105:1276–83.

    Article  PubMed  Google Scholar 

  30. Abrams JA, Fedi P, Vakiani E, et al. Depth of resection using two different endoscopic mucosal resection techniques. Endoscopy. 2008;40:395–9.

    Article  PubMed  CAS  Google Scholar 

  31. Hirota WK, Zuckerman MJ, Adler DG, et al. ASGE guideline: the role of endoscopy in the surveillance of premalignant conditions of the upper GI tract. Gastrointest Endosc. 2006;63:570–80.

    Article  PubMed  Google Scholar 

  32. May A, Gossner L, Pech O, et al. Local endoscopic therapy for intraepithelial high-grade neoplasia and early adenocarcinoma in Barrett’s oesophagus: acute-phase and intermediate results of a new treatment approach. Eur J Gastroenterol Hepatol. 2002;14:1085–91.

    Article  PubMed  Google Scholar 

  33. Ell C, May A, Pech O, et al. Curative endoscopic resection of early esophageal adenocarcinomas (Barrett’s cancer). Gastrointest Endosc. 2007;65:3–10.

    Article  PubMed  Google Scholar 

  34. Pech O, Behrens A, May A, et al. Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett’s oesophagus. Gut. 2008;57:1200–6.

    Article  PubMed  CAS  Google Scholar 

  35. Esaki M, Matsumoto T, Hirakawa K, et al. Risk factors for local recurrence of superficial esophageal cancer after treatment by endoscopic mucosal resection. Endoscopy. 2007;39:41–5.

    Article  PubMed  CAS  Google Scholar 

  36. Pouw RE, van Vilsteren FG, Peters FP, et al. Randomized trial on endoscopic resection-cap versus multiband mucosectomy for piecemeal endoscopic resection of early Barrett’s neoplasia. Gastrointest Endosc. 2011;74:35–43.

    Article  PubMed  Google Scholar 

  37. Chennat J, Konda VJ, Ross AS, et al. Complete Barrett’s eradication endoscopic mucosal resection: an effective treatment modality for high-grade dysplasia and intramucosal carcinoma–an American single-center experience. Am J Gastroenterol. 2009;104:2684–92.

    Article  PubMed  Google Scholar 

  38. Ell C, May A, Gossner L, et al. Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett’s esophagus. Gastroenterology. 2000;118:670–7.

    Article  PubMed  CAS  Google Scholar 

  39. Larghi A, Lightdale CJ, Memeo L, et al. EUS followed by EMR for staging of high-grade dysplasia and early cancer in Barrett’s esophagus. Gastrointest Endosc. 2005;62:16–23.

    Article  PubMed  Google Scholar 

  40. May A, Gossner L, Pech O, et al. Intraepithelial high-grade neoplasia and early adenocarcinoma in short-segment Barrett’s esophagus (SSBE): curative treatment using local endoscopic treatment techniques. Endoscopy. 2002;34:604–10.

    Article  PubMed  CAS  Google Scholar 

  41. Mino-Kenudson M, Brugge WR, Puricelli WP, et al. Management of superficial Barrett’s epithelium-related neoplasms by endoscopic mucosal resection: clinicopathologic analysis of 27 cases. Am J Surg Pathol. 2005;29:680–6.

    Article  PubMed  Google Scholar 

  42. Nijhawan PK, Wang KK. Endoscopic mucosal resection for lesions with endoscopic features suggestive of malignancy and high-grade dysplasia within Barrett’s esophagus. Gastrointest Endosc. 2000;52:328–32.

    Article  PubMed  CAS  Google Scholar 

  43. Pech O, May A, Gossner L, et al. Barrett’s esophagus: endoscopic resection. Gastrointest Endosc Clin N Am. 2003;13:505–12.

    Article  PubMed  Google Scholar 

  44. Buttar NS, Wang KK, Sebo TJ, et al. Extent of high-grade dysplasia in Barrett’s esophagus correlates with risk of adenocarcinoma. Gastroenterology. 2001;120:1630–9.

    Article  PubMed  CAS  Google Scholar 

  45. Lopes CV, Hela M, Pesenti C, et al. Circumferential endoscopic resection of Barrett’s esophagus with high-grade dysplasia or early adenocarcinoma. Surg Endosc. 2007;21:820–4.

    Article  PubMed  CAS  Google Scholar 

  46. Ishihara R, Iishi H, Takeuchi Y, et al. Local recurrence of large squamous cell carcinoma of the esophagus after endoscopic resection. Gastrointest Endosc. 2008;67:799–804.

    Article  PubMed  Google Scholar 

  47. Overholt BF, Wang KK, Burdick JS, et al. Five-year efficacy and safety of photodynamic therapy with Photofrin in Barrett’s high-grade dysplasia. Gastrointest Endosc. 2007;66:460–8.

    Article  PubMed  Google Scholar 

  48. Overholt BF, Panjehpour M, Halberg DL. Photodynamic therapy for Barrett’s esophagus with dysplasia and/or early stage carcinoma: longterm results. Gastrointest Endosc. 2003;58:183–8.

    Article  PubMed  Google Scholar 

  49. Shaheen NJ, Sharma P, Overholt BF, et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med. 2009;360:2277–88.

    Article  PubMed  CAS  Google Scholar 

  50. Shaheen NJ, Overholt BF, Sampliner RE, et al. Durability of radiofrequency ablation in Barrett’s esophagus with dysplasia. Gastroenterology. 2011;141:460–8.

    Article  PubMed  Google Scholar 

  51. Shaheen NJ, Greenwald BD, Peery AF, et al. Safety and efficacy of endoscopic spray cryotherapy for Barrett’s esophagus with high-grade dysplasia. Gastrointest Endosc. 2010;71:680.

    Article  PubMed  Google Scholar 

  52. Conio M, Cameron AJ, Chak A, et al. Endoscopic treatment of high-grade dysplasia and early cancer in Barrett’s oesophagus. Lancet Oncol. 2005;6:311.

    Article  PubMed  Google Scholar 

  53. Van Laethem JL, Jagodzinski R, Peny MO, et al. Argon plasma coagulation in the treatment of Barrett’s high-grade dysplasia and in situ adenocarcinoma. Endoscopy. 2001;33:257.

    Article  PubMed  Google Scholar 

  54. May A, Gossner L, Günter E, et al. Local treatment of early cancer in short Barrett’s esophagus by means of argon plasma coagulation: initial experience. Endoscopy. 1999;31:497.

    Article  PubMed  CAS  Google Scholar 

  55. Pouw RE, Wirths K, Eisendrath P, et al. Efficacy of radiofrequency ablation combined with endoscopic resection for Barrett’s esophagus with early neoplasia. Clin Gastroenterol Hepatol. 2010;8:23–9.

    Article  PubMed  Google Scholar 

  56. Herrero LA, van Vilsteren FG, Pouw RE, et al. Endoscopic radiofrequency ablation combined with endoscopic resection for early neoplasia in Barrett’s esophagus longer than 10 cm. Gastrointest Endosc. 2011;73:682–90.

    Article  PubMed  Google Scholar 

  57. van Vilsteren FG, Pouw RE, Seewald S, et al. Stepwise radical endoscopic resection versus radiofrequency ablation for Barrett’s oesophagus with high-grade dysplasia or early cancer: a multicentre randomised trial. Gut. 2011;60:765–73.

    Article  PubMed  Google Scholar 

  58. Manner H, May A, Pech O, et al. Early Barrett’s carcinoma with “low-risk” submucosal invasion: long-term results of endoscopic resection with a curative intent. Am J Gastroenterol. 2008;103:2589–97.

    Article  PubMed  Google Scholar 

  59. Swisher SG, Deford L, Merriman KW, et al. Effect of operative volume on morbidity, mortality, and hospital use after esophagectomy for cancer. J Thorac Cardiovasc Surg. 2000;119:1126.

    Article  PubMed  CAS  Google Scholar 

  60. van Lanschot JJ, Hulscher JB, Buskens CJ, et al. Hospital volume and hospital mortality for esophagectomy. Cancer. 2001;91:1574.

    Article  PubMed  Google Scholar 

  61. Dunbar KB, Spechler SJ. The risk of lymph-node metastases in patients with high-grade dysplasia or intramucosal carcinoma in Barrett’s esophagus: a systematic review. Am J Gastroenterol. 2012;107:850.

    Article  PubMed  Google Scholar 

  62. Konda VJ, Ferguson MK. Esophageal resection for high-grade dysplasia and intramucosal carcinoma: when and how? World J Gastroenterol. 2010;16:3786–92.

    Article  PubMed  Google Scholar 

  63. Schnell TG, Sontag SJ, Chejfec G, et al. Long-term nonsurgical management of Barrett’s esophagus with high-grade dysplasia. Gastroenterology. 2001;120:1607.

    Article  PubMed  CAS  Google Scholar 

  64. Reid BJ, Blount PL, Feng Z, Levine DS. Optimizing endoscopic biopsy detection of early cancers in Barrett’s high-grade dysplasia. Am J Gastroenterol. 2000;95:3089.

    Article  PubMed  CAS  Google Scholar 

  65. Weston AP, Sharma P, Topalovski M, et al. Long-term follow-up of Barrett’s high-grade dysplasia. Am J Gastroenterol. 2000;95:1888.

    Article  PubMed  CAS  Google Scholar 

  66. Konda VJ, Waxman I. Endotherapy for Barrett’s esophagus. Am J Gastroenterol. 2012;107(6):827–33.

    Google Scholar 

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Authors and Affiliations

  1. Section of Gastroenterology, Center for Endoscopic Research and Therapeutics (CERT), University of Chicago Medical Center, Chicago, IL, USA

    Wesley D. Leung MD & Irving Waxman MD, FASGE

Authors
  1. Wesley D. Leung MD
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  2. Irving Waxman MD, FASGE
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Correspondence to Irving Waxman MD, FASGE .

Editor information

Editors and Affiliations

  1. Loyola University Medical Center, Maywood, Illinois, USA

    P. Marco Fisichella

  2. Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

    Nathaniel J. Soper

  3. Department of Surgery, University of Washington Medical Center, Seattle, USA

    Carlos A. Pellegrini

  4. Chicago, Illinois, USA

    Marco G. Patti

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Leung, W.D., Waxman, I. (2014). Barrett’s Esophagus: Treatment Options and Management. In: Fisichella, P., Soper, N., Pellegrini, C., Patti, M. (eds) Surgical Management of Benign Esophageal Disorders. Springer, London. https://doi.org/10.1007/978-1-4471-5484-6_15

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  • DOI: https://doi.org/10.1007/978-1-4471-5484-6_15

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