Mayo Clinic Provides New Treatment Options for Esophageal Diseases

Esophageal Diseases Treatment

Mayo Clinic is among the first medical centers in the nation to treat early cancers of the esophagus, including Barrett esophagus, with two new treatment options: photodynamic therapy (PDT) and radiofrequency ablation (RFA).

Barrett esophagus is a premalignant condition that may result in esophageal cancer. It can occur after chronic damage from acid reflux when the normal lining of the esophagus is replaced with a red lining called "Barrett." This red lining secretes mucus and is therefore more resistant to acid than the normal white lining and it can become cancerous in some cases. Until now, there have been few treatment options for Barrett esophagus. The primary option has been surveillance by endoscopy to search for changes in the lining of the esophagus so that cancer or dysplasia, a pre-cancerous condition, can be detected in the earliest stages.

The incidence of esophageal cancer has tripled in the last 20 years, with early stages of it occurring in younger patients. Esophageal cancer arising from Barrett esophagus is the second fastest rising cancer in the U.S. Approximately 5-10 percent of patients with Barrett esophagus develop cancer.

"Mayo Clinic in Arizona is the first to perform radiofrequency ablation, and we're the only center in the world currently using the procedure to treat low-grade dysplasia," says Virender K. Sharma, M.D., director of the Esophageal Clinic. "This is significant because of the large incidence of acid reflux and the escalating rates of esophageal cancers. In a city the size of Phoenix, this treatment could potentially impact as many as 200,000 people."

Radiofrequency ablation (RFA) is a minimally invasive procedure in which a bi-polar electrode balloon is placed in the esophagus and inflated using precisely controlled radiofrequency energy. This procedure completely removes the Barrett esophagus about 40 percent of the time the first time the procedure is done and 75 percent of the time after a repeat session. RFA is done as an outpatient procedure, and is now being performed on patients with low-grade dysplasia and select patients with Barrett esophagus.

Photodynamic therapy (PDT) is another new treatment option for diseases of the esophagus. The FDA recently approved the use photodynamic therapy for patients with high-grade dysplasia. Mayo Clinic has also been using PDT in select cases of early esophageal cancer. PDT is a treatment that uses a photosensitizing drug and red laser light to kill cancer cells. Patients are given a dose of a drug called Profimer-Na that is selectively absorbed in the rapidly dividing cancerous cells. Two days later, in an outpatient procedure, an endoscope is inserted and a non-thermal laser light is shone in the esophagus onto the diseased tissue. The light activates the drug and directs it to destroy the targeted cells. This therapy can be repeated without harming normal body tissues. It can be used alone or in conjunction with other treatments, such as chemotherapy or radiation therapy.

Although both RFA and PDT provide new hope for patients with Barrett esophagus and esophageal cancers, prevention of acid reflux remains the best defense against esophageal cancer. Physicians may prescribe drugs that block the production of acid and heal irritated tissue, as well as recommend lifestyle changes and self-care tips such as getting more exercise, losing weight, avoiding foods that aggravate heartburn, stopping smoking, taking antacids and elevating the head of the bed to prevent reflux during sleep.

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SCOTTSDALE, Ariz. - http://www.mayoclinic.org