Barrett's Esophagus (BE) refers to an abnormal change (metaplasia) in the cells of the lower esophagus. When damaged by the chronic stomach acid exposure, the cells turn from squamous epithelium (normal state) to columnar epithelium (metaplasia). Barrett's Esophagus patients may face the increased risk of esophageal cancer.
Progression of Barrett Esophagus into cancer is described as below:
- Metaplasia (Barrett Esophagus or Columnar Epithelium, Cells convert into abnormal form)
- Low grade Dysplasia (Mature cells replaced by immature cells)
- High grade Dysplasia (Carcinoma in Situ, Proliferation of cancer-like cells without metastasis)
- Neoplasia (Adenocarcinoma, malignant neoplasm)
Risks of metaplasia, i.e., Barrett's Esophagus, developing into the cancer are 30-125 folds than without it. Early resection of metaplasia may completely eliminate Barrett Esophagus with less pains on swallowing and speech afterwards, and with less post-surgical medication than the open surgery removing the digestive tract.
Metaplastic tissues can be removed, and cured by Endoscopic Mucosal Resection (EMR) without invasive open surgery. The treatment is offered outpatient to be contrasted with at least 7 days hospitalization after open surgery. EMR, however, cannot resect the submucosa and barret esophagus greater than 2cm.
Above the level of Barrett's Esophagus and below the malignant neoplasia (e.g., T1a-EP, T1a-LPM, T1a-MM, T1b-SM1), Endoscopic Submucosal Dissection (ESD) may be used to resect the area of cancerous legion, given that lymph node metastasis had not occured. ESD resects only cancerous tissues, and is preferred over the open surgery, which may badly affect the swallowing and speech.
EMR and ESD was pioneered in Japan. ESD is offered almost exclusively in Japan except a few hospitals in US, and thus overseas patients in many parts of world traveled to Japan to take these endoscopic procedures.
Cost
| Endoscopic Mucosal Resection (EMR) | 100,000JPY or 1,200 USD |
|---|---|
| Endoscopic Submucosal Dissection | 400,000JPY or 5,000 USD |
|
Open Surgery with digestive reconstruction and post-surgical medication |
3,000,000JPY or 37500 USD |
Note: Costs in the table are estimates and will be different for each patient and hospital.
