Many Barrett's esophagus patients receive treatment to control acid reflux with proton-pump inhibitor (PPI) medication, which can help to resolve symptoms associated with gastric reflux like heartburn and inflammation. Treatment with PPIs can also help improve the accuracy of endoscopic evaluation. In addition, patients who have elevated risk of progressing from Barrett’s esophagus to esophageal cancer receive treatment intended to remove any worrisome areas of Barrett’s esophagus tissue and prevent progression to cancer.
Barrett’s esophagus is treated with endoscopic eradication therapy (EET), which is a combination of two therapies, endoscopic mucosal resection, and ablation. Some patients may undergo only ablation if there are no visible areas of concern. EET is an effective, minimally invasive treatment. But, it does not completely eliminate the risk of cancer.
In endoscopic mucosal resection (EMR), a thin area of esophageal tissue is removed during an endoscopy if there is a visible area of concern, such as a dysplastic lesion. This tissue can be used to confirm a Barrett’s esophagus diagnosis, and it also helps to prevent cancer by removing any tissue that is growing abnormally. Generally, endoscopic mucosal resection is followed by ablation of the remaining Barrett’s esophagus.
Endoscopic submucosal dissection may be performed if the area of precancerous cells is larger than can be removed in one piece by (EMR) or lesion of concern lacks clear borders. Submucosal resection can also remove concerning tissue from the submucosal layer, which is located beneath the mucosal layer. In the procedure, an endoscope is placed beneath the abnormal tissue, and injected liquid elevates the tissue, making it easier to remove. Unlike endoscopic mucosal resection, the procedure requires general anesthesia.
Ablation involves controlled injury through burning or freezing which destroys Barrett’s esophagus tissue, and allows the esophagus to heal with normal, healthy tissue. Ablation is often conducted as a follow-up to endoscopic mucosal resection. The procedure requires multiple treatment sessions. Once ablation is completed, it does not eliminate the need for continued endoscopic surveillance because Barrett’s esophagus can recur, and some cells may persist after treatment. There are two types of ablation therapies, which use different methods to destroy precancerous cells in the esophagus, but radiofrequency ablation (RFA) is most common.
Who needs treatment for Barrett’s esophagus?
Barrett’s esophagus patients who are identified to be at high risk of progression to cancer may benefit from treatment. Barrett’s esophagus treatment guidelines suggest that those diagnosed with high-grade dysplasia, where cells are growing abnormally and are precancerous, receive treatment. Those with low-grade dysplasia are also recommended treatment if their dysplasia has been confirmed by an expert pathologist.
However, approximately 89% of patients with Barrett's esophagus are graded as non-dysplastic or indefinite for dysplasia, and some of these patients are also at high risk of progression and would benefit from treatment (Merative™ MarketScan® Databases, 2023). For these patients, TissueCypher provides an individualized five-year risk of progression based on molecular indications of risk that cannot normally be detected by a pathologist. The TissueCypher score enables physicians to identify high-risk patients who do not have evident dysplasia so they can proceed with a risk-aligned treatment plan.