Barrett's Esophagus Treatment Center

The Barrett's Esophagus Treatment Center at Massachusetts General Hospital is one of the few multidisciplinary programs in the nation dedicated to providing comprehensive diagnosis and treatment of Barrett's esophagus. Our team includes gastroenterologists, surgeons, pathologists and nurses with longstanding expertise in medical, endoscopic and surgical management of Barrett's esophagus.

Expert Diagnostic Evaluation

In the United States, an estimated 3.3 million adults over age 50 suffer from Barrett’s esophagus, a condition affecting the lining of the esophagus. The most important step in the treatment of the condition is early diagnosis. Gastrointestinal pathologists in the Mass General Barrett’s Esophagus Treatment Center are experts in using advanced endoscopic diagnostic techniques to identify Barrett's esophagus.

Depending on the patient’s history and symptoms, the Barrett's Esophagus Treatment Center team may recommend one or more of the following diagnostic evaluations:

• Upper Gastrointestinal Endoscopy: an evaluation of the esophagus with a flexible endoscope (a thin tube with a lens and a light source at the end)
• Endoscopic Ultrasound (EUS): a specialized endoscopic imaging procedure for patients with dysplasia and/or early cancer. EUS provides detailed information about the stage of disease
• Confocal endomicroscopy: a specialized endoscopic imaging procedure that uses a flexible microscope to evaluate patients undergoing surveillance for dysplasia and/or early cancer
• Pathologic review: evaluation of tissue in the lining of the esophagus by expert pathologists

Barrett's esophagus is the most important risk factor for the development of esophageal adenocarcinoma, a cancer that is growing in incidence faster than any other in the U.S. Though the overall risk of developing esophageal cancer is low, we carefully monitor patients with dysplasia, a precancerous stage of Barrett's esophagus.

Minimally Invasive, Personalized Treatment

The Barrett's Esophagus Treatment Center team recommends personalized treatment options based on each patient’s condition. Many people with Barrett’s esophagus also have chronic acid reflux or gastroesophageal reflux disease (GERD). All treatment plans optimize medical management of GERD with antacid oral medications and lifestyle modifications. Most treatment options performed by the Mass General team are minimally invasive. Recommended treatment may include:

• Radiofrequency Ablation (RFA): An FDA-approved technique in which an electrode, mounted either on a balloon catheter or an endoscope, delivers heat energy to the diseased lining of the esophagus
• Cryotherapy: An FDA-approved technique and a type of ablation in which the Barrett' esophagus tissue is exposed to very cold temperatures, leading to the tissue’s destruction
• Endoscopic Mucosal Resection (EMR): A specialized endoscopic technique used to remove large areas of early cancers
• Esophagectomy: A major surgical procedure that involves removing the esophagus and top part of the stomach, and creating a new esophagus from remaining healthy stomach and esophagus or pharynx
• Anti-reflux surgery: A minimally invasive videoscopic procedure to restore the function of the lower esophageal sphincter (valve) so that acid and gastric contents do not continue to damage the esophagus

The Barrett's Esophagus Treatment Center works closely with colleagues in the Mass General Cancer Center and patients can be referred there for further treatment if necessary.

Innovations Through Research

Physicians of the Mass General Barrett's Esophagus Treatment Center have had a longstanding research interest in Barrett's esophagus. Our mission is to enhance the treatment and prevention of Barrett's esophagus by improving our understanding of the disease’s cause and its progression to cancer. We are actively enlisting our patients to establish a Barrett’s esophagus Patient Registry (BPR), which will house data, serum and tissue for the purposes of genomic and biomarker discovery.

Our clinicians’ research includes efforts to:

• Identify the genetic derangements that precede the development of esophageal adenocarcinoma (cancer)
• Seek biomarkers that identify patients at high risk for esophageal adenocarcinoma
• Design treatment strategies based on blocking disease pathways
• Develop new imaging techniques to detect dysplasia, which is the earliest precancerous lesion in Barrett’s esophagus
• Advance endoscopic, non-surgical therapeutic approaches for patients with Barrett’s esophagus and dysplasia