Approach Considerations, Barrett Esophagus Screening and Surveillance, Ablative Therapy for Barrett Esophagus. The goal of ablative therapy is to destroy the Barrett epithelium to a sufficient depth to eliminate the intestinal metaplasia and allow regrowth of squamous epithelium. A number of modalities have been tried, usually in combination with medical or surgical therapy because successful ablation appears to require an antacid environment. Human studies have been performed with radiofrequency ablation (RFA), photodynamic therapy (PDT), argon plasma coagulation (APC), multipolar electrocoagulation (MPEC), heater probes, various forms of lasers, endoscopic mucosal resection (EMR), and cryotherapy. Ablative therapy is emerging as a viable alternative to surgical resection or esophagectomy for patients with high- grade dysplasia in Barrett esophagus. In fact, in most major medical centers ablation is first- line therapy. A study by Prasad found that the 5- year survival rate for patients with high- grade dysplasia in Barrett esophagus who were treated with PDT and EMR was comparable to that of patients treated with esophagectomy. It is also a treatment option for low- grade dysplasia in Barrett esophgus, provided the risks and benefits are thoroughly discussed with the patient. This technique requires the use of sizing balloons to determine the inner diameter of the targeted portion of the esophagus. This is followed by placement of a balloon- based electrode with a 3- cm long treatment area that incorporates tightly spaced, bipolar electrodes that alternate in polarity. The electrode is then attached to a radiofrequency generator and a preselected amount of energy is delivered in less than 1 second at 3. W. Shaheen et al demonstrated that RFA was associated with a high rate of complete eradication of dysplasia and intestinal metaplasia and a reduced risk of disease progression in patients with dysplastic Barrett esophagus. Among patients with high- grade dysplasia, complete eradication occurred in 8. Patients in the ablation group had less disease progression than did those in the control group (3. In a randomized study of 1. Barrett esophagus and low- grade dysplasia, Phoa et al found that in comparison with endoscopic surveillance, endoscopic radiofrequency ablation (RFA) significantly reduced the rate of neoplastic progression to high- grade dysplasia or adenocarcinoma. Typically, a hematoporphyrin is used as the photosensitizing agent because it has a greater affinity for neoplastic tissue. About the BARRX Procedure. BARRX is a new treatment option for Barrett’s Esophagus, a condition that can often result from chronic heartburn or Gastroesophageal.Another agent, 5- aminolevulinic acid (ALA), which induces endogenous protoporphyrin IX and has selectivity for the mucosa over deeper submucosal layers, has also been used. The results have been promising for the regression of Barrett esophagus, as well as for the treatment of dysplasia and superficial carcinoma. Using PTD to treat 1. Overholt et al found that Barrett mucosa was completely eliminated in 4. Additionally, PDT is an expensive and time- consuming endeavor, and early use was complicated by esophageal stricture requiring dilation in 5. PDT has been largely replaced by RFA in most medical centers performing ablation. APC ablation. APC is a method of contact- free high- frequency current coagulation in which the burning of tissue stops as soon as the area is ablated. One study using high- power APC was reported to result in complete restoration of squamous mucosa in 3. The major complications were chest pain and odynophagia, which occurred in 5. Only 3 patients experienced stricture, which was treated easily with dilation. Only 1 endoscopic, as well as histologic, recurrence was observed at 1. Nissen fundoplication. Other studies have been less encouraging, with persistence of residual foci of Barrett epithelium under the neosquamous lining in 2. MPEC ablation. MPEC is a method in which the mucosa is ablated by direct contact with an electrocautery probe. Sampliner et al used this technique to treat 1. LSBE, using half of the patient's own esophagus as an internal control, and found that all 1. Acid Reflux Disease, Acalasia, Dysphagia & Other Esophagus Disorders. Benign esophageal diseases tend to deal with motility problems, or how food moves through the. Treatment took an average of 2. No adenocarcinoma or high- grade dysplasia of the esophagus developed in any of the patients. These results indicated the long- term efficacy and safety of mucosal ablation in Barrett esophagus. Laser ablation. Lasers have been used in numerous small studies for eradication of Barrett esophagus. Results were less consistent with this modality than with those listed above. Studies that demonstrated full or partial regression endoscopically were confounded by the persistence of glandular elements beneath the neosquamous epithelium in as many as one third of cases. Cryoablation. One of the newer ablative techniques is low- pressure cryospray ablation using liquid nitrogen, pioneered at the author's institution. The components of the low- pressure spray cryoablation device are as follows: Liquid nitrogen tank. Electronic console - For monitoring and controlling cryogen release. Dual foot pedal - For controlling cryogen release and heating of the catheter. Read and print UPMC patient education materials on a variety of topics, from chemotherapy drug sheets to women's health. See the listing of topics here now. Gastroesophageal reflux disease (GERD) is a digestive disorder that causes stomach acid to flow back up into the esophagus. This is known as acid reflux. The reflux. BARRETT'S ESOPHAGUS OVERVIEW. The esophagus is the tube that connects the mouth with the stomach. Barrett's esophagus occurs when the normal cells that line the. Catheter - A multilayered, 7- 9. F, open- tipped catheter for spray of supercold nitrogen gas through an upper endoscope. The mechanism of injury is unique relative to other ablative techniques. Cryoablation induces apoptosis, causes cryonecrosis at supercold temperatures (- 7. The Barrett epithelium is resistant to apoptosis and, therefore, may be uniquely suited for treatment by cryoablation. A pilot study at the author's institution using cryoablation in Barrett esophagus with degrees of dysplasia ranging from no dysplasia to multifocal, high- grade dysplasia achieved complete endoscopic reversal of Barrett esophagus in 7. SIM or dysplasia at 6- month follow- up. These results will need confirmation at other institutions. Gastroesophageal Reflux Disease - Symptoms, Diagnosis, Treatment of Gastroesophageal Reflux Disease. You can make many lifestyle changes to help treat your symptoms. Avoid foods that cause problems for you. Making changes to your routine before you go to sleep may also help. See Gastroesophageal reflux - discharge for more on managing your symptoms at home. Avoid drugs such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn). Take acetaminophen (Tylenol) to relieve pain. Take your medicines with plenty of water. When your doctor gives you a new medicine, remember to ask whether it will make your heartburn worse. You may use over- the- counter antacids after meals and at bedtime, although they do not last very long. Common side effects of antacids include diarrhea or constipation. Other over- the- counter and prescription drugs can treat GERD. They work more slowly than antacids but give you longer relief. Your pharmacist, doctor, or nurse can tell you how to take these drugs. Proton pump inhibitors (PPIs) decrease the amount of acid produced in your stomach. H2 blockers (antagonists) lower the amount of acid released in the stomach. Anti- reflux operations (fundoplication and others) may be an option for patients whose symptoms do not go away with lifestyle changes and drugs. Heartburn and other symptoms should improve after surgery, but you may still need to take drugs for your heartburn. There are also new therapies for reflux that can be performed through an endoscope (a flexible tube passed through the mouth into the stomach). In- Depth Treatment ».
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