Barrett's Esophagus

With comprehensive services and expertise focused on problems related to the esophagus, the University of Chicago Center for Esophageal Diseases offers the most advanced options for diagnosing and treating Barrett's esophagus and high-grade dysplasia.

Irving Waxman Irving Waxman, MD, and other University of Chicago gastrointestinal interventional endoscopy experts treat patients in state-of-the-art endoscopy procedure suites.

Here, patients benefit from the skill of one of the most experienced interventional endoscopist teams in the world, whose expertise focuses specifically on using minimally invasive methods to diagnose and treat Barrett's esophagus, high-grade dysplasia, and early-stage/non-invasive esophageal adenocarcinoma (a form of cancer than can progress from Barrett's esophagus). These approaches often spare patients from more invasive surgical procedures, such as esophagus removal. However, if the condition is more advanced and requires surgery, our expert surgeons can offer, when appropriate, a minimally invasive option (laparoscopic esophagectomy) or the more traditional open esophagectomy. Minimally invasive esophageal resection provides many potential benefits, such as a faster recovery and less pain.

Understanding Barrett's Esophagus

Barrett's esophagus is a precancerous condition that develops as a result of GERD (gastroesophageal reflux disease). Repeated acid and non-acid reflux into the esophagus can cause the cells that line the esophagus to change from their normal state (flat, "squamous" cells) to an abnormal state (tall, thin, "columnar" cells). Doctors call the presence of these changed cells Barrett's esophagus.

Although Barrett's esophagus is a precancerous condition, esophageal cancer only develops in about one percent of all people with Barrett's esophagus. When caught early enough, physicians can remove the abnormal cells, allowing for healthy, normal cells to grow back. Physicians at the University of Chicago are leaders in using endoscopic methods to remove abnormal cells lining the esophagus.

Diagnostic Expertise Fosters Effective Treatment

Both Barrett's esophagus and high-grade dysplasia are precancerous conditions. With both, our primary goal is to prevent the advance to invasive cancer while preserving the esophagus in both structure and function.

Minimally invasive endoscopic procedures play an important role in determining the extent of disease and removing precancerous and early-stage, noninvasive cancerous tissue from the esophagus. An endoscope is a thin, flexible tube equipped with a light and tiny camera. The endoscope is inserted through the mouth and down the esophagus. Physicians can perform different procedures through this tube.

Endoscopic methods offer key advantages over traditional surgical techniques:

  • Preserve the esophagus, so the person can swallow normally after healing;
  • Can be done as an outpatient procedure or with a brief hospital stay;
  • Less pain;
  • Minimal bleeding;
  • Faster recovery;
  • Fewer complications.

In many cases, the gastroenterology (GI) endoscopist locates and then removes abnormal cells and lesions while performing the diagnostic procedure--so the patient can avoid going through two endoscopies: first, to diagnose the problem and second, to eliminate it.

Minimally invasive procedures used to diagnose and treat Barrett's esophagus and dysplasia include:

High-Definition Endoscopy

Similar to HDTV, the latest generation of endoscopes deliver high-definition quality images, providing details of the esophageal mucosa (inner lining of the esophagus where precancerous changes start) that our endoscopists believe can reveal precancerous or early cancer changes before advanced disease occurs. Our endoscopists can use these detailed images to create minimally invasive treatment plans tailored to each patient's needs.

Additionally, our doctors are able to view tissue cells in the body at a microscopic level, using a technique called probe-based confocal laser endomicroscopy (pCLE). To perform this precise technique, we use one of the smallest microscopes in the world. In the treatment of Barrett's esophagus, physicians use pCLE to detect and remove abnormal tissue cells in a single procedure. The University of Chicago Medicine is the only hospital in the region offering this advanced technique.

Endoscopic Ultrasound (EUS)

With endoscopic ultrasound, a specially trained gastrointestinal endoscopist uses an endoscope equipped with a transducer that emits and detects sound waves as they bounce off tissue, and then sends this data to a computer. Building from this data, the computer creates an image of the inside of the esophagus to define the esophageal wall layers and surrounding structures and to identify if cancer is present and whether it has invaded beyond the initial mucosal layer of the esophagus. EUS is the most accurate technology to assess tumor (cancer) depth and the presence or absence of tumor spread to the lymph glands surrounding the esophagus. Together, high-definition endoscopy and EUS provide vital information for deciding appropriate therapy for patients with esophageal cancer.

For patients with more advanced cancer of the esophagus, EUS may be used as a tool to assist in treatment. In particular, EUS-guided injection therapy may be recommended for patients with squamous cell carcinoma of the esophagus.

Endoscopic Mucosal Resection (EMR, also called endoscopic mucosectomy)

Our team of GI endoscopists have more experience with this procedure than any other physicians in the region. University of Chicago experts have treated more cases with complete endosopic mucosectomy than any other program in the United States.

Tom Flint Our experts used EMR to treat Tom Flint's case of Barrett's esophagus that had developed into cancer. The approach saved his esophagus and gave Tom a new lease on life. »Read Tom's story

EMR removes abnormal tissue from the thin mucosal and submucosal layers that line the esophagus, while leaving the rest of the esophagus intact and functioning. These thin layers are where cell abnormalities (Barrett's, dysplasia and early-stage cancer) begin. Doctors remove the abnormal tissue to prevent precancerous or cancerous cells from invading deeper layers of the organ. Once cancer becomes invasive, esophageal surgery may be necessary. EMR aims to prevent the need for surgery while also treating the condition.

Radiofrequency Ablation (RFA, also called thermal ablation)

Like EMR, radiofrequency ablation removes precancerous or non-invasive, early-stage cancerous tissue from the mucosal linings of the esophagus--preserving the structure and function of the organ while aiming to prevent the advance of cancer. In effect, RFA uses microwave-like emissions to burn off this superficial layer inside the esophagus. New, healthy tissue grows back to replace the abnormal tissue. There is a longer track record of success with RFA than with cryoablation, a promising--yet unproven--technology that involves freezing abnormal tissue.

For patients diagnosed with invasive cancer of the esophagus, the University of Chicago Medicine offers a full array of standard and leading-edge treatment options drawing from all modalities: chemotherapy, radiation therapy and surgery. »Learn more about esophageal cancer care

A Team of Experienced Specialists

Our leading interventional endoscopist is recognized as the single most experienced physician in the U.S. for endoscopic treatment of Barrett's esophagus. The University of Chicago gastrointestinal endoscopy team performs a high volume of these procedures for patients each month, making them among the most experienced physicians in the U.S. and in the world for performing endoscopic ultrasound, endoscopic mucosal resection and radiofrequency ablation for problems of the esophagus. As pioneers in these techniques for the esophagus, our physicians are recognized leaders who continually strive to fine-tune the procedures.

Other specialists also are important members of the team dedicated to diagnosing and treating Barrett's esophagus and dysplasia. Our team includes:

  • Surgeons, who are experts in both minimally invasive laparoscopic techniques and more traditional open surgical techniques for esophagus removal (esophagectomy, esophageal resection);
  • Pathologists, who are instrumental in analyzing tissue biopsies and determining the appropriate "stage" of pre-cancer and cancerous cells. This information is critical to treatment planning;
  • Medical oncologists and radiation oncologists, who collaborate to offer patients with cancer the full array of standard and investigational treatment options available for their specific medical needs;
  • Nurses who specialize in working with patients challenged by diseases of the esophagus. Our nurses play a key role in educating patients about their diagnosis, treatment and self-care.

Research

As leaders in minimally invasive treatment of Barrett's esophagus and dysplasia, our physicians continually evaluate and fine-tune the newest methods for diagnosis and treatment of these precancerous conditions. For example, a current trial is evaluating the effectiveness of radiofrequency ablation for treating esophageal squamous dysplasia of the esophagus. Our program also benefits from translational research--an effort that brings knowledge from basic laboratory investigations to bear on clinical research and care.