July 21, 2008

Procedure May Help Those With Barrett’s Esophagus

By Liz Szabo

Today, doctors can prevent cervical and colon tumors by removing precancerous growths. In the future, they hope to use similar techniques to prevent cancer of the esophagus.

Researchers are testing procedures to eradicate abnormal cells produced by a condition called Barrett's esophagus, which results when the esophagus is burned by stomach acid, says David Fleischer, a professor at the Mayo Clinic in Arizona.

About one in 200 patients with the earliest form of Barrett's develop cancer each year. That's up to 125 times greater than the average person's risk, the American Cancer Society says.

More advanced precancers are more dangerous; about five in 100 patients develop cancer each year, says Nicholas Shaheen, an associate professor at the University of North Carolina Schools of Medicine and Public Health.

The standard treatment for Barrett's, which afflicts about 3 million people in the USA, is with acid-blocking drugs, he says. Medications help prevent new lesions but don't eliminate existing ones. Doctors also examine the esophagus with a scope every three years, says David Peura, a professor emeritus at the University of Virginia. Surgeons may operate to remove part of the esophagus if patients develop advanced precancers.

Both doctors and patients prefer to avoid such radical surgery, he says.

That's why Peura says he's encouraged by technology that may eradicate Barrett's cells without surgery. In two studies, led by Fleischer and Shaheen, doctors burned away the abnormal cells with a scope that uses radiofrequency energy in a precise area, perhaps only one or two layers deep.

In Fleischer's study, published online this month in Gastrointestinal Endoscopy, doctors eliminated 98% of the earliest type of Barrett's cells.

And in an interim analysis presented at the Digestive Diseases Week conference in May, Shaheen reported eliminating 77% of Barrett's cells in patients who received the treatment; those who had a "sham" procedure with no burning were not cured. Both studies were funded by BARRX Medical Inc., which makes the scope.

The real test, however, will be to see if these patients are less likely to develop cancer, says David Johnson, former president of the American College of Gastroenterology. Doctors need to follow patients for at least five years to measure their risk.

Shaheen says the procedure may keep Barrett's cells from advancing to more dangerous precancers: 5% of treated patients saw their cells progress, compared with 19% of patients given the sham operation.

Burning the esophageal lining poses some risks, such as bleeding, scarring or breathing problems related to being sedated during the procedure. On a scale of 1 to 10, the median pain level reported by recuperating patients was a 9, Fleischer's study showed. Although the pain was temporary, two patients in Shaheen's study were hospitalized to control pain.

Shaheen also found that advanced precancers -- the most dangerous kind -- were the hardest to treat, perhaps because they were irregularly shaped and harder to reach. (c) Copyright 2008 USA TODAY, a division of Gannett Co. Inc. <>