Barrett’s Esophagus Ablation (Endoscopic Eradication Therapy)

For Barrett’s esophagus with dysplasia (precancerous change), treatment through the endoscope can remove the abnormal lining before it becomes cancer. Dr. Campbell is the surgeon at Charlotte Harbor Surgical who offers endoscopic eradication therapy, including ablation, for appropriate patients. He will review your biopsy results and recommend the approach that fits you.

Who is it for?

• High-grade dysplasia: the 2024 AGA guideline recommends endoscopic eradication therapy over surveillance, and the 2022 ACG guideline recommends it as well.
• Low-grade dysplasia: AGA suggests endoscopic eradication therapy over surveillance, and ACG recommends it. AGA notes that patients who place more weight on the known risks of treatment may reasonably choose surveillance.
• Barrett’s without dysplasia: AGA suggests against routine treatment. For non-dysplastic Barrett’s with a high-risk TissueCypher® result, Castle Biosciences states that clinicians may consider treatment or closer surveillance. Guidelines have not set a single rule for this group, so Dr. Campbell decides with you, case by case.
• Dysplasia should first be confirmed by an expert pathologist, as AGA and ACG advise.

How endoscopic eradication therapy works

Treatment is done through an upper endoscope under sedation, usually as an outpatient procedure.

• Remove visible lesions first: any raised or irregular area is removed with endoscopic resection, usually endoscopic mucosal resection (EMR), so it can be examined by the pathologist. AGA suggests resecting visible lesions and then ablating the rest of the Barrett’s segment.
• Ablate the remaining Barrett’s lining: ablation destroys the abnormal lining so healthy lining can grow back. AGA names radiofrequency ablation (RFA) as the preferred ablation method. ACG notes that cryotherapy (freezing) may be considered as an alternative when Barrett’s does not respond to RFA.
• More than one treatment session may be needed to clear the Barrett’s lining.

Like any procedure, treatment has risks, which can include chest discomfort or painful swallowing for a short time and, less often, narrowing of the esophagus (stricture), bleeding or perforation. Dr. Campbell will go over the benefits and risks for you.

After treatment

Surveillance endoscopy continues after treatment, because Barrett’s can come back. For patients treated for high-grade dysplasia, AGA advises surveillance at 3, 6 and 12 months after treatment is complete, then every year. For low-grade dysplasia, AGA advises surveillance at 1 and 3 years after the Barrett’s is cleared, then the intervals used for Barrett’s without dysplasia. Acid-suppressing medicine is usually continued, and reflux control remains part of your care.

Related

• Barrett’s esophagus surveillance & TissueCypher®
• Upper endoscopy (EGD)
• Reflux, hiatal hernia & foregut surgery

Sources

1. AGA Clinical Practice Guideline on Endoscopic Eradication Therapy of Barrett’s Esophagus and Related Neoplasia (2024).
2. Shaheen NJ, et al. Diagnosis and Management of Barrett’s Esophagus: An Updated ACG Guideline. Am J Gastroenterol. 2022;117(4).
3. AGA Clinical Practice Update on New Technology and Innovation for Surveillance and Screening in Barrett’s Esophagus: Expert Review (2022).
4. Castle Biosciences: TissueCypher® “Our Test” (patient information).

Where surgery is performed

Dr. Campbell operates at AdventHealth Port Charlotte and Murdock Surgery Center. Consultations and follow-up visits take place at the Charlotte Harbor Surgical office in Port Charlotte.