Barrett's esophagus is a change in the lining of the esophagus that resembles intestinal tissue and is caused by long-standing acid reflux. Over time, precancerous changes can develop and in some cases can turn into esophageal cancer. The specialists of NewYork-Presbyterian’s esophageal disorders program treat one of the largest volumes of individuals with Barrett’s esophagus in state-of-the-art facilities, offering comprehensive diagnostic testing and endoscopic and surgical treatments. Our goals are to relieve your symptoms, cure your disease, and ultimately prevent it from progressing to esophageal cancer.
A Team of Barrett’s Esophagus Specialists
The care of people with Barrett’s esophagus requires a team of specialists with the expertise to make an accurate diagnosis and to choose the most appropriate treatments. Your team includes gastroenterologists, interventional endoscopists, surgeons, radiologists, nutritionists, nurses, and others with the clinical expertise, compassion, and skills to provide the highest quality care for Barrett’s esophagus.
Making an Accurate Diagnosis
The most effective care for Barrett’s esophagus begins with an accurate diagnosis. At NewYork-Presbyterian, we have an array of advanced techniques to diagnose Barrett’s esophagus and detect precancerous changes or early cancer, including methods not routinely available elsewhere. To determine if you have this disorder and to assess its severity, our doctors use:
- High Definition White Light Endoscopy. By inspecting the inside of your esophagus using a flexible tube with a camera at its tip, your gastroenterologist can see and remove abnormal tissue to determine if you have Barrett’s esophagus.
- Narrow band imaging (NBI). With this endoscopic technique, your doctor uses a special system to capture high-resolution images of the inner surface of your esophagus without the use of dyes. NBI relies on the fact that light of different wavelengths penetrates tissue at different depths. The longer the wavelength, the deeper the tissue penetration. Using light of different wavelengths, your doctor can see fine features of tissue in your esophagus, aiding the detection of precancerous changes or early cancer within areas of Barrett’s esophagus.
- Confocal/Laser Endomicroscopy. This advanced imaging technique permits high-resolution assessment of the esophageal mucosa (top most lining) at a cellular and subcellular level. It provides an “optical biopsy” which may allow for targeted biopsies of abnormal mucosal thickening decreasing the number of biopsies needed and increasing diagnostic yield.
- Optical Coherence Tomography (OCT). This noninvasive advanced imaging technique uses light waves to provide comprehensive deep imaging to improve the detection of dysplastic and cancerous lesions of Barrett’s esophagus.
Advanced Treatment for Barrett’s Esophagus
The specialists at NewYork-Presbyterian work together to provide you with coordinated, individualized care using the latest technologies. Our goal is to preemptively remove or destroy precancerous changes of the esophagus before the cells turn into esophageal cancer.
- Radiofrequency ablation (RFA). Our endoscopists use an advanced form of ablation (tissue destruction) that delivers heat energy in a precise and highly controlled manner to destroy the abnormal cells lining the esophagus. With this safe therapy, we can remove abnormal Barrett’s esophagus tissue without damaging the normal underlying structures. You may experience complete disappearance of Barrett’s esophagus after RFA therapy.
- Cryotherapy. This treatment involves the use of a super-cooled liquid or gas to freeze the abnormal cells of Barrett's esophagus. The effect of the treatment is similar to RFA, with the destruction of Barrett’s tissue and replacement with normal esophagus lining. We also use it in people whose Barrett’s esophagus could not be cured with RFA and select patients with early esophageal cancer.
- Endoscopic mucosal resection (EMR). Our endoscopists use this technique to endoscopically remove Barrett’s esophagus nodules (raised lesions) that contain precancerous changes or early cancer. We allow the area to heal and then treat the remaining Barrett’s segment with one of the above ablative therapies. EMR may enable people with early cancerous lesions to forego surgery.
- Endoscopic Submucosal Dissection (ESD). This technique allows for the removal of large areas of precancerous changes or early esophageal cancer in a single, outpatient procedure. Our center is one of the few in the region that performs this highly specialized technique.
- Surgery for Barrett’s esophagus. If you have a large or deep lesion in your esophagus, you may need surgery to remove the abnormal tissue. The upper gastrointestinal and thoracic surgeons at NewYork-Presbyterian are highly skilled in performing the full range of surgical techniques for the esophagus and use minimally invasive approaches whenever possible, returning you to your normal activities sooner.
Access to Clinical Trials
Our team of specialists is involved in numerous trials aimed at studying novel treatments for Barrett’s esophagus and precancerous changes. We are constantly striving to identify new ways to lower the risk of esophageal cancer.