ACTA FAC. MED. NAISS. 2004; 21 (2): 59-63

     Reviewl article
 

    HERAPEUTIC OPTIONS IN PATIENTS WITH BARRETT’S ESOPHAGUS

    Daniela Benedeto-Stojanov¹, Aleksandar Nagorni¹, Goran Bjelaković¹, Vesna Brzački¹, Suzana Raičević-Sibinović¹, Dragan Stojanov<sup>2

    1</sup>Clinic of Gastroenterology and Hepatology, Clinical Center Niš
    2Institute of Radiology, Clinical Center Nis

   
    SUMMARY

     Barrett’s esophagus (BE) is associated with an increased risk of developing adenocarcinoma. Cancer development is preceded by dysplastic changes. Management strategies for BE are based on a patient’s dysplasia status. Advances in endoscopic treatment make early malignancies, for which surgical resection is the only accepted therapy, amenable for minimally invasive endoscopic treatment. Endoscopic mucosal resection (EMR) is a minimally invasive endoscopic technique that can be used in patients with circumscribed mucosal carcinomas. The technique is also useful as a diagnostic procedure by obtaining a full-thickness mucosal specimen for histologic examination. Photodynamic therapy (PDT) using the prodrug 5-aminolevulinic acid, is an ablative therapy that destroys the esophageal mucosa leaving the deeper layers of the esophageal wall intact. Cell damage is achieved by the action of light on the photosensitizing agent protoporphyrin IX in the mucosa, with skin photosensitivity of less than 48 hours. Such mucosal ablation, however, can also be accomplished with more common thermal techniques like Argon plasma coagulation (APC). In all these ablative procedures, squamous regeneratin is obtained by rigorous antacid therapy.
    In selected patients these endoscopic ablation methods, although still experimental, might already offer an alternative to esophagectomy. The need for further improvement in conjunction with the lack of long-term follow-up data, however, limits the use of these techniques to expert centers.

    Key words: Barrett’s esophagus, medical treatment, surgical treatment, endoscopic treatment