Interventional gastroenterologists at Rush are now treating Barrett's esophagus with a noninvasive ablation procedure that removes harmful tissue using radiofrequency energy.
Barrett's esophagus is a precancerous condition in which a thin layer of tissue lining the lower esophagus is damaged due to chronic acid reflux. Presently, Barrett's is estimated to affect about 3.3 million adults. Each year 86,000 new cases are diagnosed. Men are at greatest risk and, although Barrett's esophagus can be found at any age, the prevalence increases with advancing age until it plateaus for those in their 60s.
Twenty percent of the U.S. population is believed to suffer from the reflux disease. Forty-four percent of adults in the United States experience symptoms of gastroesophageal reflux disease (GERD) almost monthly, while 18 percent experience symptoms weekly.
According to Sri Komanduri, MD, an interventional gastroenterologist at Rush, if Barrett's esophagus goes untreated, it can advance to esophageal
cancer. Barrett's esophagus progresses to cancer at a rate of less than one percent per patient per year. The majority of patients who develop an
advanced esophageal cancer are unaware that they have Barrett's esophagus.
"Now that technology is available to treat Barrett's disease before it progresses to cancer, there is an opportunity to impact this projection and ultimately improve the quality of life for the millions of Americans living with Barrett's esophagus," says Komanduri.
"The incidence of esophageal cancer, which killed 14,000 in the United States last year, is rising faster than any other cancer in the United States," says Komanduri. Until recently, patients underwent frequent endoscopies to determine whether the disease had progressed — from precancerous lesions to cancer. Now, Barrett's esophagus can be treated — and eliminated — through an endoscopic removal of nodules or superficial growths (endoscopic mucosal resection) or ablation treatment which is performed with the standard upper endoscopy."
For the procedure, Komanduri uses a three component system of a sizing balloon, an ablative energy generator and an ablation catheter. He places a balloon catheter into the esophagus during endoscopy. After the balloon is inflated, radiofrequency energy is delivered, removing the diseased tissue lining the esophagus. The procedure takes less than 26 minutes and is performed on an outpatient basis.
Clinical trials in the United States have demonstrated that in the majority of procedures, Barrett's esophageal tissue was removed and replaced with normal, healthy tissue.
"Prior to the availability of this new therapy, the only treatment available for Barrett's esophagus involved frequent surveillance endoscopies to look for any progression to dysplasia (precancerous tissue) or cancer," says Komanduri. "The procedure eliminates the precancerous condition known as Barrett's — however, it does not control GERD."
Using standard endoscopic skills, the physician directs the ablation catheter to the diseased area of the esophagus. The HALO energy generator is then activated to deliver a short burst of ablative energy, which removes a very thin layer of the diseased esophagus.
The procedure is performed without incisions using conscious sedation in an out-patient setting. Minor discomfort, which may be experienced by some patients, can be well-managed with medication. Following ablation therapy, patients resume acid suppression therapy.
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Please note: All physicians featured in Discover Rush Online are on the medical faculty of Rush University Medical Center. Some of the physicians featured are in private practice and, as independent practitioners, are not agents or employees of Rush University Medical Center.
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