Leaders in Minimally Invasive Treatment Options for Barrett's Esophagus

The University of Chicago Medicine Center for Esophageal Diseases offers the most advanced options for diagnosing and treating Barrett's esophagus, high-grade dysplasia, and early-stage/non-invasive esophageal adenocarcinoma — a form of cancer than can progress from Barrett's esophagus. Our patients benefit from the skill of one of the most experienced interventional endoscopy teams in the world, who specialize in using minimally invasive methods. These approaches often spare patients from more invasive surgical procedures, such as esophagus removal. However, if the condition is advanced and requires surgical removal, our expert surgeons can offer laparoscopic esophagectomy, a less invasive esophageal resection that provides many potential benefits, such as a faster recovery and less pain.

Understanding Barrett's Esophagus

Barrett's esophagus is a precancerous condition that develops as a result of gastroesophageal reflux disease (GERD). Repeated acid and non-acid reflux in the esophagus can cause the cells that line the esophagus to change from their normal state (flat, "squamous" cells) to an abnormal state (tall, thin, "columnar" cells). Doctors call the presence of these changed cells Barrett's esophagus.

Although Barrett's esophagus is a precancerous condition, esophageal cancer only develops in about 1 percent of all people with Barrett's esophagus. When caught early enough, physicians can remove the abnormal cells, allowing for healthy, normal cells to grow back. Our primary treatment goal is to prevent invasive cancer and preserve the structure and function of the esophagus.

Physicians at UChicago Medicine are leaders in using endoscopic methods to diagnosis and remove abnormal cells lining the esophagus. In many cases, our gastroenterology endoscopists can locate and remove abnormal cells and lesions during the diagnostic procedure so the patient can avoid going through two endoscopies.

An endoscopy is a minimally invasive procedure in which our team determines the state of the disease and removes precancerous and early-stage cancerous tissue from the esophagus. An endoscope — a thin, flexible tube equipped with a light and tiny camera — is inserted through the mouth and down the esophagus. Physicians can perform different procedures through this tube.

Endoscopic methods offer key advantages over traditional surgical techniques, including:

  • Faster recovery
  • Fewer complications
  • Less pain
  • Minimal bleeding
  • Performed as an outpatient procedure or with a brief hospital stay
  • Preserving the esophagus, so the patient can swallow normally after healing

Our head of our interventional endoscopy program is recognized as the single most experienced physician in the United States for endoscopic treatment of Barrett's esophagus. UChicago Medicine's gastrointestinal endoscopy team performs a high volume of these procedures for patients each month, making them among the most experienced physicians in the U.S. and in the world for performing endoscopic ultrasound, endoscopic mucosal resection and radiofrequency ablation for esophagus conditions.

Other specialists are also important members of the team dedicated to diagnosing and treating Barrett's esophagus and dysplasia. Our team includes:

  • Surgeons: Experts in both minimally invasive laparoscopic techniques and more traditional open surgical techniques for esophagus removal (esophagectomy, esophageal resection.
  • Pathologists: Instrumental in analyzing tissue biopsies and determining the appropriate stage of pre-cancer and cancerous cells. This information is critical to treatment planning.
  • Medical oncologists and radiation oncologists: Collaborate to offer patients with cancer the full array of standard and investigational treatment options available for their specific medical needs.
  • Nurses: Specialize in working with patients challenged by esophageal diseases. Our nurses play a key role in educating patients about their diagnosis, treatment and self-care.

As leaders in minimally invasive treatment of Barrett's esophagus and dysplasia, our physicians continually evaluate and fine-tune the newest methods for diagnosis and treatment of these precancerous conditions. Our program also benefits from translational research — an effort that brings knowledge from basic laboratory investigations to bear on clinical research and care.

Types of Endoscopic Procedures

Below is a list of minimally invasive procedures used to diagnose and treat Barrett's esophagus and dysplasia.

The latest generation of endoscopes deliver high-definition quality images, providing details of the esophageal mucosa (the inner lining of the esophagus where precancerous changes start) that our endoscopists believe can reveal precancerous or early cancer changes before advanced disease occurs. Our endoscopists can use these detailed images to create minimally invasive treatment plans tailored to each patient's needs.

Additionally, our doctors are able to view tissue cells in the body at a microscopic level, using a technique called probe-based confocal laser endomicroscopy (pCLE). To perform this precise technique, we use one of the smallest microscopes in the world. In the treatment of Barrett's esophagus, physicians use pCLE to detect and remove abnormal tissue cells in a single procedure. UChicago Medicine is the only hospital in the region offering this advanced technique.

With endoscopic ultrasound, a specially trained gastrointestinal endoscopist uses an endoscope equipped with a transducer that emits and detects sound waves as they bounce off tissue and then sends this data to a computer. Building from this data, the computer creates an image of the inside of the esophagus to define the esophageal wall layers and surrounding structures. It can identify if cancer is present and whether it has invaded beyond the initial mucosal layer of the esophagus. EUS is the most accurate technology to assess tumor depth and the presence or absence of tumor spread to the lymph glands surrounding the esophagus. Together, high-definition endoscopy and EUS provide vital information for deciding appropriate therapy for patients with esophageal cancer.

For patients with more advanced cancer of the esophagus, EUS may be used as a tool to assist in treatment. In particular, EUS-guided injection therapy may be recommended for patients with squamous cell carcinoma of the esophagus.

Endoscopic Mucosal Resection (EMR, also called endoscopic mucosectomy)

Our team of GI endoscopists have the most experience with this procedure in the region. UChicago Medicine's experts have treated more cases with complete endosopic mucosectomy than any other program in the United States.

EMR removes abnormal tissue from the thin mucosal and submucosal layers that line the esophagus, while leaving the rest of the esophagus intact and functioning. These thin layers are where cell abnormalities (Barrett's, dysplasia and early-stage cancer) begin. Doctors remove the abnormal tissue to prevent precancerous or cancerous cells from invading deeper layers of the organ. Once cancer becomes invasive, esophageal surgery may be necessary. EMR aims to prevent the need for surgery while also treating the condition.

Radiofrequency Ablation (RFA, also called thermal ablation)

Like EMR, radiofrequency ablation removes precancerous or non-invasive, early-stage cancerous tissue from the mucosal linings of the esophagus — preserving the structure and function of the organ while aiming to prevent the advance of cancer. In effect, RFA uses microwave-like emissions to burn off this superficial layer inside the esophagus. New, healthy tissue grows back to replace the abnormal tissue. There is a longer track record of success with RFA than with cryoablation, a promising — yet unproven — technology that involves freezing abnormal tissue.

For patients diagnosed with invasive cancer of the esophagus, UChicago Medicine offers a full array of standard and leading-edge treatment options drawing from all modalities: chemotherapy, radiation therapy and surgery.

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