Barrett's Esophagus

Esophageal Cancer

The Esophagus

Barrett's esophagus is a precancerous condition that arises in the lining of the esophagus.

Patients with gastroesophageal reflux disease or GERD are at increased risk for the development of Barrett's and the most common cancer of the esophagus called adenocarcinoma.

Personalized Care

I have heartburn and am concerned that I might have Barrett's.
We offer expedited endoscopy to those who have never had it before to carefully screen for Barrett's. You or your physician can call
215-214-1460 to schedule an endoscopic examination.

I have Barrett's and am concerned about developing cancer.
We provide endoscopy with systematic tissue sampling and expert pathological analysis to look for any any concerning changes in Barrett's. Call the Barrett's Program at 215-214-1460.

I have complicated Barrett's (dysplasia, nodules) and wonder whether I need surgery.
We tailor a full range of treatment options to best fit the patient's disease status and either avoid surgery where  possible or proceed to surgery when needed. We welcome the opportunity to provide second opinions to patients who may need advanced care. Schedule an initial clinic appointment in the Barrett's Program at 215-214-1460.

 

Treatment Team

Gastroenterologists
Stephen J. Heller, MD
Gregory H. Enders, MD, PhD
Jeffrey L. Tokar, MD
David S. Weinberg, MD, MSc
Minhhuyen T. Nguyen, MD

Pathology
Harry S. Cooper, MD

Surgical Oncology
Walter J. Scott, MD
Prashant C. Shah, MD

 

VATS for EsophagectomiesMinimally Invasive Esophagectomies

Fox Chase is a regional center of excellence in esophageal surgery with high patient volumes.

Over 20 minimally invasive esophagectomies have been performed, the largest number in the Philadelphia area.

With conventional, open surgery, an esophagectomy required a laparotomy (accessing the abdominal cavity through an incision in the abdominal wall) and thoracotomy (a large incision between the ribs).

Today, using minimally invasive techniques, such as video assisted thoracic surgery (VATS), surgeons can perform esophagectomies with fewer complications, improved quality of life and better outcomes, and without compromising oncologic principles.

We believe the care of patient's Barrett's Esophagus must be individualized. At Fox Chase, our philosophy is to provide compassionate care based on a thorough, personalized assessment of the patient's condition, taking into account the patient's overall medical history, his or her individual priority and needs, and a careful analysis of biopsy material.

The Best Care:

Treatment Options for Barrett's Esophagus

Until recently, the best way to care for patients with Barrett's esophagus without cancer was to simply monitor patients with periodic endoscopy. Once cancer was detected, or more worrisome changes suggesting a progression to cancer were seen, the patient was referred for surgery. However, we now have at our disposal at Fox Chase some very useful treatments via the endoscope. These valuable treatments can, in many cases, prevent the need for surgery and the development of cancer.

Radiofrequency Ablation (RFA) This technique uses a special catheter inserted through a standard endoscope, which generates energy to cauterize and eradicate the Barrett's cells. Research studies have shown that this technique is safe and effective in the vast majority of cases in eliminating Barrett's tissue with dysplastic (precancerous) cells.

Cryotherapy In this procedure, the physician applies liquid nitrogen spray through the endoscope to eliminate Barrett's tissue. Like radiofrequency ablation, this technique appears to be quite effective in eradicating Barrett's cells. Fox Chase is one of the few centers in the Delaware Valley that can offer this treatment. Cryotherapy appears to be safe and effective not only in eliminating dysplastic Barrett's tissue; we also use this technique in some patients with cancer of the esophagus to reduce the size of esophageal tumors and improve patients' ability to swallow.

Endoscopic Ultrasound For patients with Barrett's esophagus and nodules, or some early cancer in Barrett's, we perform perform upper endoscopy with endoscopic ultrasound to assess the thickness of the nodule or lymph node involvement. This helps guide our approach to treatment.

Endoscopic Mucosal Resection For patients with Barrett's esophagus with localized precancerous nodules, or some very early cancers, the best treatment is endoscopic mucosal resection (EMR). In this procedure, the physician performs an endoscopy and mechanically removes the abnormal nodular tissue using specialized accessories designed expressly for this purpose. Unlike RFA and cryotherapy, EMR provides tissue for biopsy. At Fox Chase, our highly trained and experienced physicians are skilled in this advanced endoscopic technique.

Surgery Even with the wide variety of advanced endoscopic techniques available, surgery is still the best option for some patients. Our highly skilled thoracic surgeons specialize in cancer surgery, and are trained in state-of-the-art surgical techniques including minimally invasive esophageal surgery. Our volume of esophageal surgery at Fox Chase is among the highest in the Delaware Valley.

Research

Fox Chase has an active research program to improve assessment of risk for cancer development in Barrett’s. Patients are offered the option of enrolling in this program, which examines additional biopsies using advanced molecular methods. Call the Barrett's Program at 215-214-1460.

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NCI PDQ
See National Cancer Institute information on Esophageal Cancer
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