The treatment of Barrett's esophagus

Abstract

The reflux of the gastric juice in the esophagus can determine the injury of the esophageal epithelium. When the healing of the lesion is done by replacing the normal squamous epithelium with columnar epithelium, the entity is called Barrett's esophagus (BE). Although controversial, some studies showed 0,5% per year the incidence of the esophageal adenocarcinoma in patients with BE, 30 times more often than general population. Taking into consideration the possible development of an adenocarcinoma, the patients with Barrett's esophagus require endoscopic surveillance after a standardized protocol. There is still much controversy about the treatment of patients with Barrett's esophagus, especially in the presence of dysplasia. The aims of the treatment are gastro-esophageal reflux symptoms control, healing of associated esophagitis and prevention of development of adenocarcinoma.

Fig. 1

Norman Rupert Barrett (1903 - 1979)

Fig. 2

Columnar epithelium – Barrett’s esophagus

Fig. 3

Barrett’s esophagus, negative for dysplasia, HE, 4x

Fig. 4

Barrett’s esophagus, low-grade dysplasia, HE, 4x.

Fig. 5

COX2 expression in Barrett’s esophagus, IHC, 40x

Fig. 6

Troncular vagotomy, antrectomy and duodenal diversion with gastro-jejunal Roux anastomosis

Fig. 7

Highly selective vagotomy, Nissen fundoplication and duodenal switch

Fig. 8

Merendino procedure

Fig. 9

Abdomino-cervical esophagectomy with gastric pull-up