Barrett’s Esophagus appears in 10% of patients with prolonged Gastroesophageal Reflux Disease (GERD), a condition present in 40% of the population.
The new unit aims to promote the study, monitoring and treatment, in a multidisciplinary mode, of patients suffering from Barrett’s Esophagus with dysplasia or early carcinoma.
- In recent years endoscopic treatment techniques have been developed for early forms of adenocarcinoma in Barrett’s Esophagus that allow the disease to be completely cured and to reduce the risk of new neoplastic cells.
Barrett’s Esophagus (hereinafter BE) is a condition appearing in 10% of patients suffering from prolonged Gastroesophageal Reflux Disease (hereinafter GERD), a condition present in 40% of the population and which is characterized by acidity in the stomach, heartburn and regurgitation. Particularly, BE is an alteration in which the cells that cover the interior wall of the stomach – squamous epithelium- are replaced by other cells – metaplastic columnar epithelium. Despite these cells not being malignant, it is estimated that their presence in the esophagus increases by up to 30 times the risk of developing esophageal adenocarcinoma.
For that reason, MD Anderson Cancer Center Madrid has launched the Barrett’s Esophagus Unit with the aim of promoting the study, monitoring and multidisciplinary treatment of patients with Barrett’s Esophagus with dysplasia or early carcinoma. Although to a lesser degree, the new service will also attend patients with Barrett’s Esophagus who wish to submit to a specific monitoring endoscopic study with greater sensitivity with which to detect dysplasia than the standard study.
The creation of this new unit is fruit of the close collaboration between the Gastroenterology and Digestive Surgery services at MD Anderson Cancer Center Madrid. Doctors Alberto Herreros de Tejada (Gastroenterology) and Oscar Alonso Casado (Digestive Surgery) act as coordinators of the unit.
BE is particularly common in white men, with a certain degree of obesity and a prolonged history of pyrosis (GERD). Detecting BE is particularly important to be able to monitor the condition in the long term and for early detection of the initial forms of dysplasia or adenocarcinoma by means of gastroscopy.
“The creation of specific units to deal with BE is fundamental to expanding the range of treatments for cancer of the esophagus in its very early stages. The detection of this type of cancer in its advanced stages is associated with a negative prognosis, so at MD Anderson Cancer Center Madrid, we want to be in a position to stop the development of the disease in time”, explains Dr Oscar Alonso Casado.
New techniques for diagnosis in the early stages.
“In recent years, endoscopic techniques have been developed for the treatment of early forms of dysplasia and adenocarcinoma in cases of BE and permitting the complete cure of the disease and the reduction of posterior risks of developing new neoplastic cells, like endoscopic mucosectomy and radiofrequency ablation”, comments Dr Alberto Herreros de Tejada.
- Endoscopic Mucosectomy, which consists of the resection of segments of esophageal mucosa and submucosa by means of special techniques. The results of the studies carried out using this technique for the treatment of high grade dysplasia and intramucosal adenocarcinoma show rates of a complete cure and survival at 5 years of 85-98%.
- Radiofrequency ablation, which permits submitting tissue to radiofrequency energy applied by means of balloons adjusted uniformly to the circumference of the esophagus. The technique allows for the homogeneous elimination of the diseased epithelia of BE, so that the risk of future cases of dysplasia or adenocarcinoma in people already diagnosed and/or treated is reduced remarkably.
- Gastroscopy with chromoendoscopy following a special protocol for biopsies to correctly diagnose and monitor BE with dysplasia.
- Upper Echoendoscopy for local staging of esophageal cancer
- Antireflux surgical techniques using laparoscopy in select cases requiring adequate control of the GERD.
- Oncologic esophagectomy techniques for cases that cannot be treated using endoscopic techniques.