barrett esophagus mucosectomy, radiofrequency application

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In 1950, a British physician, Norman Rubert Barrett, described Barrett’s esophagus with a case published in the British Medical Journal.

Barrett’s esophagus (also called Barrett’s epithelium or Barrett’s metaplasia) can be defined as the replacement of the epithelial tissue covering the inner surface of the esophagus by a tissue similar to the tissue covering the inner surface of the stomach and/or intestines (metaplasia).

It is more common in patients whose disease occurs at a young age, who have reflux symptoms during sleep, who have bleeding due to reflux, or who have narrowing at the lower end of the esophagus due to chronic reflux.

Barrett’s tissue can be seen during endoscopy, but endoscopic diagnosis alone is not reliable, histopathological examination should be done by taking a tissue sample for definitive diagnosis (biopsy).

Before the development of cancer (precancerous) in the Barrett’s epithelium, there may be some changes called dysplasia that can only be detected by biopsy.r.

How Is Barret's Esophagus Treated?

Drug treatment in Barrett’s esophagus cannot eliminate the metaplasia, but effective doses of drugs that suppress gastric acid secretion and surgical intervention in appropriate cases can reduce the risk of cancer development in the presence of Barrett’s esophagus. To date, there are some endoscopic methods to eliminate and treat Barrett metaplasia (Argon plasma coagulation, photodynamic therapy (HALO) etc.). These methods can only be applied in experienced centers and the effectiveness of these methods in preventing cancer is not certain.

Radiofrequency Ablation Treatment in Barrett's Esophagus

barrett özafagusunda ilaç tedavisiBarret’s esophagus is the histopathological displacement of the mucosa at the lower end of the esophagus with specialized intestinal metaplasia tissue. This is a result of reflux.

Traditionally, esophagectomy was performed in Barret’s esophagus cases with high-grade dysplasia or intra-mucosal cancer, while endoscopic follow-up was recommended in cases with low-grade dysplasia or non-dysplastic Barret’s esophagus.

Less invasive endoscopic treatments have been developed as both of these methods have their own disadvantages. Esophagectomy surgery had disadvantages such as high morbidity and mortality, and intermittent endoscopic scans had disadvantages such as skipping cancer foci or inability to detect or detect cancer development in the interim.

The radiofrequency ablation method for Barret’s esophagus is a promising endoscopic method. Primarily, circular ablation is performed, and then the remaining tissue is incised, secondarily, with special devices through the endoscope.

Compared to photodynamic therapy and argon plasma coagulation therapy, this method does not show any residual Barret’s esophageal mucosa buried. In the first two methods, buried Barret’s esophagus foci can remain under the mucosa called “Burried Barret’s esophagus”.

Indications for radiofrequency ablation in Barret’s esophagus. Radiofrequency ablation can be performed after endoscopic mucosal resection or after the visible lesion has been treated with endoscopic mucosal resection in cases of Barret’s esophagus with intra-mucosal carcinoma or high-grade dysplasia.

Radiofrequency ablation alone is not recommended. If there is submucosal involvement in the examination of the tissue taken after endoscopic mucosal resection, they may spread to the peripheral lymph nodes at a rate of 15-30%, these cases should be submitted to surgery.

On the other hand, only cases with intra mucosal carcinoma are suitable candidates for radiofrequency ablation. Radiofrequency ablation can be applied in these patients.

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