Barretts Esophagus

Patients with Barrett's esophagus (BE) are advised to undergo endoscopic surveillance with multiple biopsies to detect HGD and/or early adenocarcinoma (AC). Several endoscopic methods have been used to remove HGD, including photodynamic therapy (PDT) and Argon Plasma Coagulator (APC), but the disadvantage is the lack of final histological assessment. Moreover, PDT with photofrin caused severe esophageal stenoses in 34% of patients. EMR could become a therapeutic alternative to esophagectomy in these patients (Table 6-2).

Most of the published studies report EMR of endo-scopically visible areas of HGD or early AC (Table 6-3). EMR changes the pathologic stage in a significant number of patients.

The risk of overlooking simultaneous associated foci of malignancy is greater for patients with long extension of BE. The reported frequency of undetected cancer is about 50%. For this reason, the gold standard therapy is still represented by esophagogastrectomy. However, surgery is associated with a significant mortality rate, ranging between 3 and 5%. When HGD is detected in tongues of BE patients (s 30 mm), without endoscopic abnormalities, and not involving the entire circumference of the esophagus, EMR can remove all the metaplastic epithelium.

Constipation Prescription

Constipation Prescription

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