Barrett’s esophagus is a pathological change in the lining of the esophagus caused by chronic gastroesophageal reflux disease (GERD).
It is known that chronic GERD causes changes that lead to inflammation, necrosis and apoptosis of the esophageal mucosa, which in the healing phase differentiates into intestinal mucosa, which is more resistant to the acidic stomach fluids.
“The replacement of the normal lining of the esophagus by a lining that resembles that of the small intestine is called Barrett’s esophagus or “intestinal metaplasia” and is a precancerous stage.
If this is not treated, there is a high possibility that it will develop into adenocarcinoma”, points out Mrs. Eleni Karafoka – Mavrou, Surgeon, Director of the 2nd Clinical Robotic Surgery and Surgical Oncology Metropolitan General.
Why is the diagnosis and monitoring of Barrett’s esophagus important?
10 – 15% of GERD patients develop Barrett’s esophagus and of these, 10% will develop esophageal cancer. In other words, patients with Barrett’s esophagus are twice as likely as the general population to develop esophageal cancer.
This fact makes it particularly imperative to treat reflux disease surgically (Nissen domeplasty) before the appearance of intestinal metaplasia (Barrett), but also the need for very close follow-up of patients with Barrett’s esophagus, with the aim of early and timely detection occurrence of cancer.
How is the diagnosis made?
“The diagnosis is made by esophagoscopy and is documented by taking biopsies and their pathological examination. In the endoscope, the disease gives a very characteristic image, which is easily recognized by an experienced endoscopist. By taking multiple biopsies, the presence of “intestinal metaplasia” is recognized which establishes the diagnosis, but also of “cellular atypia” which is considered a pre-cancerous condition.
In this case, depending on the severity of the atypia, the patient will be referred for surgical treatment (esophagectomy) or enter a close monitoring protocol every six months or every three months.
It is important to mention that the presence of Barrett’s esophagus is an absolute indication for surgical treatment of reflux disease, in order to remove the stimulus, however intestinal metaplasia rarely resolves on its own”, explains the doctor.
Treatment
There are currently no medications to reverse Barrett’s esophagus. However, if the underlying reflux is treated, disease progression can be delayed.
At an advanced stage and following specific endoscopic criteria, Barrett’s esophagus can be treated endoscopically, with controlled local application of radio frequencies (HALO ablation). This procedure targets only the superficial layer of the esophagus in the area where intestinal metaplasia is identified and destroys it. Treatment works in combination with concurrent treatment for reflux.
The definitive treatment of GOP is only surgical treatment. The operation performed is called a Nissen vault. In this operation the upper part of the stomach, called the dome, is wrapped around the lower part of the esophagus like a life jacket, creating a high pressure zone that pushes the esophagus from the outside. The aim is to create an external pressure valve, which prevents reflux. The operation is now only done robotically or laparoscopically and in experienced hands has excellent results.
The surgery is performed under general anesthesia. The surgical robot offers many advantages compared to the simple laparoscopic method. The vision is three-dimensional and with very high magnification. There is no bleeding as long as even very small vessels are identified and treated accordingly.
“After this, the patient does not need a transfusion, he does not feel pain, he is mobilized very quickly, thus avoiding thrombosis and respiratory infections and more. He also enters the hospital on the day of the surgery.
The day after the surgery, an x-ray check is done to make sure everything is as it should be. On the same day (and for about a week) he is fed with mushy – watery foods and in the afternoon he can go home.
With the application of minimally invasive techniques (robotic and laparoscopic), the severity of the surgery, compared to earlier times when it was done with a large incision, has been reduced and the effects on the patient have been almost zero. The effectiveness of the method is proven. After the surgery, the patient returns to his normal life without restrictions and prohibitions”, concludes Mrs. Karafoka – Mavrou.
She writes:
Mrs. Eleni Karafoka – Mavrou, Surgeon,
Director of the 2nd Clinical Robotic Surgery and Surgical Oncology Metropolitan General
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