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Johns Hopkins Pediatric

Treatment for Barrett's Esophagus: From Monitoring to Surgery

Johns Hopkins Surgery
February 1, 2014

Richard Battafarano: “We think many carcinomas that occur in people were probably Barrett’s at some point.”

When it comes to patients with Barrett's esophagus, says Richard Battafarano, we've learned that the most critical part of treatment is close monitoring, particularly in light of recent projections by the American Cancer Society of a potential rise in esophageal cancer.

"We think many of the carcinomas that occur in people were probably Barrett's at some point," he says. "This is an increasing problem, and we can't forget it."

The condition, a complication of gastric esophageal reflux disease, is most often found when patients don't respond to standard reflux treatments and an endoscopy is performed by a gastroenterologist.

"Once acid suppression is achieved and the reflux esophagitis has resolved, usually through lifestyle changes and high-dose antacid medications," says Battafarano, director of the Division of Thoracic Surgery at Johns Hopkins, "gastroenterologists will manage the condition and recommend short-interval surveillance endoscopy. For those with high-grade dysplasia, endoscopic ablation is generally considered."

"We are monitoring Barrett's much more carefully now as compared with five or 10 years ago," Battafarano says. "It seems obvious, but we now understand that without surveillance endoscopy, there's no way to tell if the condition is progressing toward cancer."

Surgical Interventions for Barrett's Esophagus

When Barrett's patients present with high-grade dysplasia or intramucosal adenocarcinoma, it's then that gastroenterologists and thoracic surgeons collaborate closely in determining the right time to surgically intervene. "A lot of care and discussion takes place between the teams in assessing these patients," says Battafarano.

There are three different types of esophagectomies available for Barrett's patients with high-grade dysplasia or invasive adenocarcinoma, and all of them are available at Johns Hopkins. One approach is performed via a small laparotomy and a small right thoracotomy, while another is done by laparotomy and a neck incision. A third approach is a minimally invasive procedure that is performed through a laparoscopic (abdominal) and thoracoscopic (thoracic) approach. Each of these types of esophagectomy has advantages and disadvantages, so every attempt is made to match the surgical approach to the patient's needs. "We're very fortunate to have surgeons who specialize in each method, in addition to a world-class team of gastroenterologists with whom we work."

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