Surveillance (Barrett's esophagus)
At the Center for Minimally Invasive Esophageal Therapies at Boston Medical Center, we specialize in the latest and most effective management techniques for Barrett's esophagus, including endoscopic surveillance. Our team of highly trained and experienced specialists takes a collaborative approach to your treatment. We draw on medical expertise, state-of-the-art facilities, and a patient-centered environment to provide you with not only the best medicine but also the best medical care in New England.
Barrett's esophagus is a condition characterized by chronic acid reflux that continually irritates the esophagus and can cause precancerous cells to grow. When the lower esophageal sphincter (the valve that keeps acid stomach contents away from the esophagus) does not stay closed, backflow into the esophagus creates a burning sensation, and can lead to cell changes. The lining of the esophagus then becomes more like that of the intestinal lining. This process is called intestinal metaplasia or Barrett's metaplasia. This can lead to esophageal cancer.
For most people with Barrett's esophagus, physicians recommend periodic endoscopic examinations to make sure that these changes are not worsening and starting to develop early cancer changes. This is called surveillance. Endoscopic surveillance combines upper endoscopy, in which your physician threads an endoscope (a narrow, flexible tube with a tiny light and camera at the tip) through your mouth and into your esophagus. He or she then takes tissue samples from the esophagus for laboratory analysis (biopsy).
In the laboratory, a pathologist examines the cells and looks for cell changes called dysplasia, which are considered pre-cancerous. Dysplasia is the next stage in the progression from Barrett's to cancer. There are two stages of dysplasia, an earlier stage called low-grade dysplasia and a more severe stage called high-grade dysplasia. How often you undergo endoscopic surveillance depends on the level of dysplasia found during a biopsy.
One approach that physicians at Boston Medical Center have been using to treat Barrett's or dysplasia is mucosal ablation. There are three types of mucosal ablation methods:
Your surgeon will discuss which of these is most appropriate for depending on the severity of your Barrett's or dysplasia. During mucosal ablation, the abnormal lining of the esophagus is removed during an endoscopy. Following this, the esophagus will heal and the abnormal lining will be replaced with healthy normal esophageal lining. It will still be important, however, to continue to undergo surveillance after the abnormal tissue has been removed.
How to Prepare
Tell your doctor if you have any allergies to medication or have had problems with anesthesia. Your doctor will give you any specific instructions about dietary or activity restrictions, as well as whether or not you should take your regular medications on the day of the procedure. You will be asked not to eat or drink after midnight on the night before your procedure. You may wish to ask a friend or family member to drive you to your procedure.
What to Expect
You will be positioned on an examining table, and an intravenous (IV) line will be started in a vein in your arm to give you medications and fluids during and after your endoscopy. You may be given a form of sedation called "conscious sedation," which will help you relax and diminish your gag reflex. You may also have a full general anesthetic.
Your doctor will examine the lining of your esophagus by passing an endoscope, which is a flexible, lighted tube with a video camera attached to it, through your mouth and throat. The camera attached to the endoscope transmits magnified images to a video monitor, which enables your doctor to examine closely the lining of your esophagus. Your doctor will then pass an instrument through the endoscope to remove small samples of the Barrett's esophagus cells for biopsy. Your doctor may take several small (about the size of half a grain of rice each) tissue samples for analysis.
Once your doctor has taken enough tissue samples, the instrument and endoscope are removed and the procedure is complete. It can take between 20 minutes and one hour depending on how long the Barrett's metaplasia or dysplasia is and whether or not mucosal ablation needs to be carried out.
After your endoscopy, you will be taken to a recovery area until you are awake and alert. Because of the use of a sedative or anesthetic, you will not be able to drive and should arrange for a ride home. You may also need to stay in the hospital overnight.