Monitoring with periodic endoscopy and biopsy is crucial. Barrett’s can degenerate into cancer in stages. Within Barrett’s when precancerous changes can be seen, this is called dysplasia and is further broken down into low-grade and high-grade dysplasia. This spectrum from Barrett’s to low-grade to high-grade dysplasia and then cancer can be diagnosed on biopsy. Dysplasia represents progressive damage to the DNA within cells, which become more irregular and abnormal. If patients have “normal” Barrett’s, then the cancer risk is low, but this increases with the presence of dysplasia.
According to the American College of Gastroenterology, the following maintenance schedule for endoscopy is recommended. All patients should be on antacid medications prior to endoscopy to eliminate any inflammation of the esophagus, which might cloud the diagnosis. Patients diagnosed with Barrett’s on endoscopy should have another endoscopy one year later to ensure no changes have developed. Then they should have endoscopy and biopsies every 3 years. If low-grade or mild dysplasia is found, then yearly endoscopy and biopsy should be done. If high-grade dysplasia is found, this can be a marker of cancer and the situation becomes very complicated. The short answer is surgery to remove the esophagus may be needed but for the sake of discussion other options may be available.
The benefit of this recommended surveillance endoscopy for Barrett’s is that dysplasia can be diagnosed and followed more closely before cancer develops. If cancer does occur, it can be detected long before it would have caused any symptoms. Therefore, if it is diagnosed at an earlier stage, it becomes more treatable or curable.
What Can I Do If I Have Barrett’s Esophagus? References
By Mortin - Copyright 2009
Last modification 31/12/2009