barrett`s esophagus management , screening and endoscopic approach

2. .

3. What is Barrett`s Esophagus ??

5. How to Diagnose ??

28. How to Treat Barret`s
Esophagus??

30. Therapy of Barrett’s Esophagus
• Antisecretory therapy
• Surgery
• Ablation
• Chemoprevention

33. Anti-reflux Surgery
•Antireflux surgery is not more effective than medical
therapy for prevention of cancer in Barrett’s
esophagus.
• We recommend against attempts to eliminate
esophageal acid exposure (PPIs in doses >once daily
or antireflux surgery) for cancer prevention.
Gastroenterology 2011;140:1084

35. Endoscopic Mucosal Resection EMR
Endoscopic mucosal resection is an alternative to
surgery in the management of Barrett`s with:
• high grade intraepithelial dysplasia
• intramucosal cancer.
However, nodal metastases should first be excluded by
endoscopic ultrasound (EUS)

37. Advantages of EMR
less invasive than surgery
unlike ablative treatments,
provides tissue for histological assessment.

38. Common EMR techniques for Barrett's oesophagus
“Inject and cut” technique
“Simple snare resection” technique
Cap assisted endoscopic mucosal resection
Endoscopic mucosal resection with ligation
EMR strategies used for Barrett's oesophagus
Localised EMR
Circumferential EMR

44. Summary of management of Barrett`s
Esophagus
No Dysplasia Low G Dysplasia High G
Dysplasia
Follow up endoscopy /3 ys. Follow up /6 months or Endoscopic eradication
endoscopic ablation