Barrett's Esophagus

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Diagnosis

To diagnose Barrett's esophagus, an outpatient procedure called upper GI endoscopy with biopsy (also called upper endoscopy or esophagogastroduodenoscopy) is performed. Prior to upper endoscopy, the patient is given a sedative and the throat is sprayed with a local anesthetic.

During the procedure, a thin, flexible tube that contains a tiny light and camera (called an endoscope) is passed through the mouth and into the esophagus, stomach, and the first part of the small intestine (duodenum).

Using the endoscope, the physician can examine the lining of the upper gastrointestinal (GI) tract, including the esophageal lining. If abnormal tissue is found, a small sample can be removed using surgical instruments that are passed through the endoscope. This tissue is examined under a microscope to detect abnormal cells (metaplasia) and confirm a diagnosis of Barrett's esophagus. Surgical removal of a tissue sample for microscopic evaluation is called a biopsy.

Upper GI endoscopy usually takes about 30 minutes to perform. Before undergoing the procedure, the patient should avoid eating or drinking for at least 6 hours. Some patients experience a sore throat following upper endoscopy. Complications are rare and include bleeding and organ perforation.

Screening for Barrett's esophagus (i.e., performing diagnostic tests on patients who do not have symptoms) usually is not recommended. However, some physicians recommend that patients who have had symptoms of GERD (e.g., chronic acid reflux) for a number of years undergo upper GI endoscopy at the age of 40 to detect abnormal tissue (metaplasia). If results of the test are normal, it should be repeated about every 3 years.

Due to an increased risk for esophageal cancer, upper endoscopy with biopsy may be performed regularly in patients who have Barrett's esophagus. This sometimes is referred to as surveillance endoscopy.

The recommended length of time between tests varies, often depending on the severity of the condition. For example, surveillance endoscopy may be performed every 3 months in patients who have large areas of abnormal esophageal tissue or high-grade dysplasia. In patients who have small areas of abnormal tissue, metaplasia, or low-grade dysplasia, the test may be performed less often (e.g., once every 1 to 3 years).

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