Esophageal dysplasia

Dysplasia is a precancerous lesion. Various factors, including alcohol and tobacco consumption, as well as gastro-oesophageal reflux, can alter the type of cells lining the oesophagus (e.g. Barrett’s oesophagus). In some cases, this increases the risk of cancer. It is now possible to detect precancerous lesions and, in some cases, remove them (endoscopic resection by mucosectomy or submucosal dissection (ESD)) or ablate them by burning them (radiofrequency).

Thanks to the expertise of the team and the latest-generation endoscopes available at Erasme Hospital’s Endoscopy Clinic, these precancerous lesions can be identified with great precision and treated optimally, thereby limiting the need for oesophageal surgery and the risk of disease progression. The multidisciplinary approach specific to the academic hospital makes it possible to discuss each patient jointly with the surgical, oncology and radiology teams, in order to offer each patient the best possible treatment.

If you have undergone an endoscopy that demonstrated the presence of Barrett’s oesophagus or dysplastic lesions (precancerous lesions), and would like the opinion of Erasme’s specialist team, please do not hesitate to make an appointment for a consultation (by email at ConsGastroMed [dot] erasme [at] hubruxelles [dot] be (ConsGastroMed[dot]erasme[at]hubruxelles[dot]be) or by telephone on +32 (0)2 555.35.04. Depending on your medical file, a new endoscopic assessment may be proposed using our latest-generation endoscopes, in order to determine the best treatment to offer. 

High-grade dysplasia in Barrett’s oesophagus: What is it? 

Barrett’s oesophagus is a change in the type of cells lining the lower part of the oesophagus, resulting from several factors, including gastro-oesophageal reflux. Endoscopic monitoring, through detailed image analysis and biopsies, makes it possible to detect any dysplasia (precancerous lesions).

Current virtual and acetic acid chromoendoscopy techniques improve detection capabilities. Dysplastic lesions with a clearly visible lesion must be distinguished from those without a visible lesion.

How can dysplasia in Barrett’s oesophagus be treated?

If dysplasia is detected, the first step is to perform a new endoscopy by an expert using a latest-generation endoscope, under optimised acid-suppression treatment (proton pump inhibitors), within 3 months of the initial endoscopy. This examination will determine whether or not there is a visible lesion and clarify its size and predictive nature. In addition, the initial biopsy specimens will be reviewed by an expert anatomical pathologist to confirm or rule out the presence of dysplasia.

If a visible lesion is considered superficial, the treatment of choice is endoscopic resection, either by endoscopic mucosal resection (EMR) (for lesions smaller than 15 mm) or by endoscopic submucosal dissection (ESD) (for lesions larger than 15 mm). These two techniques are performed in the therapeutic endoscopy rooms at Erasme Hospital. If the specimen shows no contraindication to continuing endoscopic treatment, ablation of the residual Barrett’s oesophagus will be proposed at a later stage, depending on the patient’s age, general health and life expectancy.

In the absence of a visible lesion, if high-grade dysplasia is confirmed in new Barrett’s oesophagus biopsies, and following endoscopic resection for HGD or a pT1 carcinoma, ablation of the Barrett’s oesophagus will be proposed according to the above-mentioned criteria, using radiofrequency ablation (RFA).

Regarding EMR, ESD or RFA:

• You will be positioned on an examination table. The procedure may last 30–90 minutes and is performed under anaesthesia for your comfort.
• An endoscope will be inserted through your mouth, allowing a detailed examination of the Barrett’s mucosa.
• For a resection, after lifting the tissue by submucosal injection, the affected tissue will be removed using an instrument with an electrocautery current.
• For RFA, a probe or balloon will be applied to rapidly and standardisedly burn the surface affected by Barrett’s oesophagus. With treatment using proton pump inhibitors, the tissue will heal without residual Barrett’s oesophagus. Treatment cycles will be performed every 3 months until the Barrett’s oesophagus has disappeared, with a maximum of 5 sessions per patient.

After remission (disappearance of dysplasia and Barrett’s intestinal metaplasia, both in terms of endoscopic appearance and biopsy results), a structured endoscopic follow-up programme will be arranged (endoscopy every 6 months during the first year, followed by annual endoscopy). Long-term treatment with proton pump inhibitors will be prescribed.

What happens after endoscopic treatment?

After the procedure, you will remain in hospital for at least one night to ensure that you do not develop abdominal pain, which generally subsides during the first 12 hours. You will receive acid-suppression treatment and a puréed diet for a few days.

Complications related to these treatments are rare. The most common is pain. Scar-related stenosis may occur in 5–10% of cases.

Our hospital is accredited by INAMI to use radiofrequency to treat Barrett’s oesophagus by endoscopy (in cases of precancerous lesions or following the removal of an early-stage cancer). In addition, Erasme Hospital is accredited by INAMI as a referral centre for oesophageal surgery (a specialised centre operating under a convention), making this multidisciplinary approach crucial for providing patients with better treatment. Finally, the team has published several scientific papers on the subject in recent years, demonstrating the pioneering nature of the endoscopy clinic in this field.

As members of a leading academic hospital, our healthcare professionals conduct scientific research projects to advance medicine and continuously improve the quality of care provided to patients.