Download PDF
CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2012; 03(S 05): 017-022
DOI: 10.4103/0976-5042.95025
Review Article
Society of Gastrointestinal Endoscopy of India

Endoscopic therapy for Barrett′s esophagus

Nicholas J. Shaheen
Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
› Author Affiliations
Further Information

Publication History

Publication Date:
26 September 2019 (online)

Also available at
  PDF Download Permissions and Reprints

Abstract

Barrett’s esophagus (BE) is the precursor lesion to esophageal adenocarcinoma. This cancer has undergone a rapid increase in incidence in Western societies in the last 30 years. Current practices seek to lower the risk of death from this cancer by performing screening upper endoscopy on those with chronic reflux symptoms, and then surveillance upper endoscopy on those found to have BE at periodic intervals. While this approach is intuitively appealing, no data substantiate a decreased cancer risk with these practices, and substantial issues limit the effectiveness of this approach. This article outlines the current approaches to BE, their shortcomings, and presents data supporting the use of endoscopic therapy for subjects with BE and dysplasia. A significant and growing literature supports the use of endoscopic therapy in BE, and this approach, combined with improved risk stratification, may improve our care of subjects with BE.

Key words

Gastroesophageal reflux - barrett’s esophagus - dysplasia - surveillance endoscopy - radiofrequency ablation
 

  • References

  • 1 Pohl H, Welch HG. The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. J Natl Cancer Inst 2005;97:142-6.
  • 2 Shaheen N, Ransohoff DF. Gastroesophageal reflux, barrett esophagus, and esophageal cancer: Scientific review. JAMA 2002;287:1972-81.
  • 3 Jovov B, Van Itallie CM, Shaheen NJ, Carson JL, Gambling TM, Anderson JM, et al. Claudin-18: A dominant tight junction protein in Barrett’s esophagus and likely contributor to its acid resistance. Am J Physiol Gastrointest Liver Physiol 2007;293: G1106-13.
  • 4 Wang KK, Sampliner RE. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett’s esophagus. Am J Gastroenterol 2008;103:788-97.
  • 5 Winters C Jr, Spurling TJ, Chobanian SJ, Curtis DJ, Esposito RL, Hacker JF 3rd, et al. Barrett’s esophagus. A prevalent, occult complication of gastroesophageal reflux disease. Gastroenterology 1987;92:118-24.
  • 6 Locke GR 3rd, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ 3rd. Prevalence and clinical spectrum of gastroesophageal reflux: A population-based study in Olmsted County, Minnesota. Gastroenterology 1997;112:1448-56.
  • 7 Nebel OT, Fornes MF, Castell DO. Symptomatic gastroesophageal reflux: Incidence and precipitating factors. Am J Dig Dis 1976;21:953-6.
  • 8 Shaheen NJ, Crosby MA, Bozymski EM, Sandler RS. Is there publication bias in the reporting of cancer risk in Barrett’s esophagus? Gastroenterology 2000;119:333-8.
  • 9 O’Connor JB, Falk GW, Richter JE. The incidence of adenocarcinoma and dysplasia in Barrett‘s esophagus: Report on the Cleveland Clinic Barrett’s Esophagus Registry. Am J Gastroenterol 1999; 94:2037-42.
  • 10 Drewitz DJ, Sampliner RE, Garewal HS. The incidence of adenocarcinoma in Barrett‘s esophagus: A prospective study of 170 patients followed 4.8 years. Am J Gastroenterol 1997;92:212-5.
  • 11 Streitz JM Jr, Andrews CW Jr, Ellis FH Jr. Endoscopic surveillance of Barrett’s esophagus. Does it help? J Thorac Cardiovasc Surg 1993;105:383-7; discussion 387-8.
  • 12 Shaheen NJ, Provenzale D, Sandler RS. Upper endoscopy as a screening and surveillance tool in esophageal adenocarcinoma: A review of the evidence. Am J Gastroenterol 2002;97:1319-27.
  • 13 van Sandick JW, van Lanschot JJ, Kuiken BW, Tytgat GN, Offerhaus GJ, Obertop H. Impact of endoscopic biopsy surveillance of Barrett’s oesophagus on pathological stage and clinical outcome of Barrett’s carcinoma. Gut 1998; 43:216-22.
  • 14 Corley DA, Levin TR, Habel LA, Weiss NS, Bu-er PA. Surveillance and survival in Barrett’s adenocarcinomas: A population-based study. Gastroenterology 2002;122:633-40.
  • 15 Inadomi JM, Sampliner R, Lagergren J, Lieberman D, Fendrick AM, Vakil N. Screening and surveillance for Barrett esophagus in high-risk groups: A cost-utility analysis. Ann Intern Med 2003;138:176-86.
  • 16 Montgomery E, Bronner MP, Goldblum JR, Greenson JK, Haber MM, Hart J, et al. Reproducibility of the diagnosis of dysplasia in Barrett esophagus: A rea-rmation. Hum Pathol 2001;32:368-78.
  • 17 Alikhan M, Rex D, Khan A, Rahmani E, Cummings O, Ulbright TM. Variable pathologic interpretation of columnar lined esophagus by general pathologists in community practice. Gastrointest Endosc 1999;50:23-6.
  • 18 Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, et al. Hospital volume and surgical mortality in the United States. New Engl J Med 2002;346:1128-37.
  • 19 Shaheen NJ, Green B, Medapalli RK, Mitchell KL, Wei JT, Schmitz SM, et al. The perception of cancer risk in patients with prevalent Barrett’s esophagus enrolled in an endoscopic surveillance program. Gastroenterology 2005;129:429-36.
  • 20 Crockett SD, Lippmann QK, Dellon ES, Shaheen NJ. Health-related quality of life in patients with Barrett’s esophagus: A systematic review. Clin Gastroenterol Hepatol 2009;7:613-23.
  • 21 Falk GW, Ours TM, Richter JE. Practice patterns for surveillance of Barrett‘s esophagus in the United States. Gastrointest Endosc 2000;52:197-203.
  • 22 van Sandick JW, Bartelsman JF, van Lanschot JJ, Tytgat GN, Obertop H. Surveillance of Barrett‘s oesophagus: Physicians’ practices and review of current guidelines. Eur J Gastroenterol Hepatol 2000;12:111-7.
  • 23 Biere SS, Cuesta MA, van der Peet DL. Minimally invasive versus open esophagectomy for cancer: A systematic review and meta-analysis. Minerva Chir 2009;64:121-33.
  • 24 Gammon MD, Schoenberg JB, Ahsan H, Risch HA, Vaughan TL, Chow WH, et al. Tobacco, alcohol, and socioeconomic status and adenocarcinomas of the esophagus and gastric cardia. J Natl Cancer Inst 1997;89:1277-84.
  • 25 Chow WH, Blot WJ, Vaughan TL, Risch HA, Gammon MD, Stanford JL, et al. Body mass index and risk of adenocarcinomas of the esophagus and gastric cardia. J Natl Cancer Inst 1998;90:150-5.
  • 26 Sampliner RE, Fennerty B, Garewal HS. Reversal of Barrett‘s esophagus with acid suppression and multipolar electrocoagulation: Preliminary results. Gastrointest Endosc 1996;44:532-5.
  • 27 Dulai GS, Jensen DM, Cortina G, Fontana L, Ippoliti A. Randomized trial of argon plasma coagulation vs. multipolar electrocoagulation for ablation of Barrett’s esophagus. Gastrointest Endosc 2005;61:232-40.
  • 28 Overholt BF, Panjehpour M, Haydek JM. Photodynamic therapy for Barrett’s esophagus: Follow-up in 100 patients. Gastrointest Endosc 1999;49:1-7.
  • 29 Norberto L, Polese L, Angriman I, Erroi F, Cecchetto A, D’Amico DF. High-energy laser therapy of Barrett’s esophagus: Preliminary results. World J Surg 2004;28:350-4.
  • 30 Overholt BF, Lightdale CJ, Wang KK, Canto MI, Burdick S, Haggitt RC, et al. Photodynamic therapy with porfimer sodium for ablation of high-grade dysplasia in Barrett’s esophagus: International, partially blinded, randomized phase III trial. Gastrointest Endosc 2005;62:488-98.
  • 31 Wani S, Puli SR, Shaheen NJ, Westhoff B, Slehria S, Bansal A, et al. Esophageal adenocarcinoma in Barrett’s esophagus after endoscopic ablative therapy: A meta-analysis and systematic review. Am J Gastroenterol 2009;104:502-13.
  • 32 Schulz H, Miehlke S, Antos D, Schentke KU, Vieth M, Stolte M, et al. Ablation of Barrett’s epithelium by endoscopic argon plasma coagulation in combination with high-dose omeprazole. Gastrointest Endosc 2000;51:659-63.
  • 33 Shand A, Dallal H, Palmer K, Ghosh S, MacIntyre M. Adenocarcinoma arising in columnar lined oesophagus following treatment with argon plasma coagulation. Gut 2001;48:580-1.
  • 34 Attwood SE, Lewis CJ, Caplin S, Hemming K, Armstrong G. Argon beam plasma coagulation as therapy for high-grade dysplasia in Barrett’s esophagus. Clin Gastroenterol Hepatol 2003;1:258-63.
  • 35 Ackroyd R, Tam W, Schoeman M, Devitt PG, Watson DI. Prospective randomized controlled trial of argon plasma coagulation ablation vs. endoscopic surveillance of patients with Barrett’s esophagus after antireflux surgery. Gastrointest Endosc 2004;59:1-7.
  • 36 Sharma P, Wani S, Weston AP, Bansal A, Hall M, Mathur S, et al. A randomised controlled trial of ablation of Barrett’s oesophagus with multipolar electrocoagulation versus argon plasma coagulation in combination with acid suppression: Long term results. Gut 2006;55:1233-9.
  • 37 Barr H, Shepherd NA, Dix A, Roberts DJ, Tan WC, Krasner N. Eradication of high-grade dysplasia in columnar-lined (Barrett’s) oesophagus by photodynamic therapy with endogenously generated protoporphyrin IX. Lancet 1996;348:584-5.
  • 38 Ackroyd R, Brown NJ, Davis MF, Stephenson TJ, Marcus SL, Stoddard CJ, et al. Photodynamic therapy for dysplastic Barrett’s oesophagus: A prospective, double blind, randomised, placebo controlled trial. Gut 2000;47:612-7.
  • 39 Buttar NS, Wang KK, Lutzke LS, Krishnadath KK, Anderson MA. Combined endoscopic mucosal resection and photodynamic therapy for esophageal neoplasia within Barrett‘s esophagus. Gastrointest Endosc 2001;54:682-8.
  • 40 Overholt BF, Panjehpour M, Halberg DL. Photodynamic therapy for Barrett‘s esophagus with dysplasia and/or early stage carcinoma: Long-term results. Gastrointest Endosc 2003;58:183-8.
  • 41 Sharma VK, Wang KK, Overholt BF, Lightdale CJ, Fennerty MB, Dean PJ, et al. Balloon-based, circumferential, endoscopic radiofrequency ablation of Barrett’s esophagus: 1-year follow-up of 100 patients. Gastrointest Endosc 2007;65:185-95.
  • 42 Lyday WD, Corbett FS, Kuperman DA, Kalvaria I, Mavrelis PG, Shughoury AB, et al. Radiofrequency ablation of Barrett’s esophagus: Outcomes of 429 patients from a multicenter community practice registry. Endoscopy 2010;42:272-8.
  • 43 Shaheen NJ, Sharma P, Overholt BF, Wolfsen HC, Sampliner RE, Wang KK, et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med 2009;360:2277-88.
  • 44 Velanovich V. Endoscopic endoluminal radiofrequency ablation of Barrett’s esophagus: Initial results and lessons learned. Surg Endosc 2009;23:2175-80.
  • 45 Dumot JA, Vargo JJ 2nd, Falk GW, Frey L, Lopez R, Rice TW. An open-label, prospective trial of cryospray ablation for Barrett’s esophagus high-grade dysplasia and early esophageal cancer in high-risk patients. Gastrointest Endosc 2009;70:635-44.
  • 46 Greenwald BD, Dumot JA, Horwhat JD, Lightdale CJ, Abrams JA. Safety, tolerability, and e-cacy of endoscopic low-pressure liquid nitrogen spray cryotherapy in the esophagus. Dis Esophagus 2010;23:13-9.
  • 47 Barham CP, Jones RL, Biddlestone LR, Hardwick RH, Shepherd NA, Barr H. Photothermal laser ablation of Barrett’s oesophagus: Endoscopic and histological evidence of squamous re-epithelialisation. Gut 1997;41:281-4.
  • 48 Fleischer DE, Overholt BF, Sharma VK, Reymunde A, Kimmey MB, Chuttani R, et al. Endoscopic ablation of Barrett’s esophagus: A multicenter study with 2.5-year follow-up. Gastrointest Endosc 2008;68:867-76.
  • 49 Becker V, Vieth M, Bajbouj M, Schmid RM, Meining A. Confocal laser scanning fluorescence microscopy for in vivo determination of microvessel density in Barrett’s esophagus. Endoscopy 2008;40:888-91.
  • 50 Kang D, Suter MJ, Boudoux C, Yoo H, Yachimski PS, Puricelli WP, et al. Comprehensive imaging of gastroesophageal biopsy samples by spectrally encoded confocal microscopy. Gastrointest Endosc 2010;71:35-43.
  • 51 Kara MA, DaCosta RS, Streutker CJ, Marcon NE, Bergman JJ, Wilson BC. Characterization of tissue autofluorescence in Barrett’s esophagus by confocal fluorescence microscopy. Dis Esophagus 2007;20:141-50.
  • 52 Adler DC, Zhou C, Tsai TH, Lee HC, Becker L, Schmitt JM, et al. Three-dimensional optical coherence tomography of Barrett’s esophagus and buried glands beneath neosquamous epithelium following radiofrequency ablation. Endoscopy 2009;41:773-6.
  • 53 Mannath J, Subramanian V, Hawkey CJ, Ragunath K. Narrow band imaging for characterization of high grade dysplasia and specialized intestinal metaplasia in Barrett’s esophagus: A meta-analysis. Endoscopy 2010;42:351-9.
  • 54 Curvers W, Baak L, Kiesslich R, Van Oijen A, Rabenstein T, Ragunath K, et al. Chromoendoscopy and narrow-band imaging compared with high-resolution magnification endoscopy in Barrett’s esophagus. Gastroenterology 2008;134:670-9.
  • 55 Prasad GA, Wang KK, Buttar NS, Wongkeesong LM, Krishnadath KK, Nichols FC 3rd, et al. Long-term survival following endoscopic and surgical treatment of high-grade dysplasia in Barrett’s esophagus. Gastroenterology 2007;132:1226-33.
  • 56 Inadomi JM, Somsouk M, Madanick RD, Thomas JP, Shaheen NJ. A Cost-Utility Analysis of Ablative Therapy for Barrett’s Esophagus. Gastroenterology 2009;136:2101-14:e1-6.