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About the Barrett’s Esophagus Center of Excellence
Background
Established in 1988, our Barrett’s Esophagus Center of Excellence at Fort Sanders Regional Medical Center is an alliance of many medical professionals from several departments, research organizations and supporting services that provide comprehensive and well-coordinated care for Barrett’s patients.
This partnership has resulted in the introduction of new treatments for patients and the development of new technologies for early detection of dysplasia and cancer.
Our Center is internationally known as a leader in the treatment of Barrett’s esophagus. We gained this reputation as a result of innovations in protocol development, excellent treatment outcomes in a large number of patients, numerous publications and book chapters, and extensive presentations at national GI conferences. Photodynamic therapy (PDT) for Barrett’s esophagus was pioneered in 1990 at our center. The laser light delivery balloon for the procedure was developed and tested in our animal laboratory, followed by clinical development at our clinic. This work led to FDA approval of a multi-center international study for treatment of Barrett’s esophagus, which was conducted under the direction of our center’s Medical Director.
Our center was one of the first institutions to introduce Radiofrequency ablation (BÂRRX procedure) for treatment of Barrett’s esophagus and has treated thousands of Barrett’s patients so far. Over three decades of experience has resulted in excellent treatment outcomes in our patients. Our patients have been referred to our center from all areas of the United States and from other countries. To date, we have treated thousands of patients from 44 states and several foreign countries.
State of the Art Treatment and Technology
The center is a state-of-the-art outpatient specialized endoscopy clinic equipped to provide an array of treatment options for patients with Barrett’s esophagus to include Radiofrequency Ablation (RFA) using a variety of HALO devices, Endoscopic Mucosal Resection (EMR), Argon Plasma Coagulation (APC), cryotherapy, bipolar, and monopolar electrocoagulation procedures.
GERD diagnostic procedures such as Bravo pH monitoring and 24 hour pH/Impedance monitoring are also available at the Center. Endoscopic ultrasound (EUS) for staging of esophageal cancer is provided at the GI Lab endoscopy clinic at Fort Sanders Regional.
Our Research Program
We are committed to improving patient care and treatment outcomes through research. The clinical research program has been active since 1989 investigating photodynamic therapy (PDT) and other ablation procedures such as radiofrequency ablation and cryotherapy. Through clinical research, our Center has obtained over 36 years of extensive experience in treating Barrett’s esophagus and early esophageal cancer.
The preclinical research program was conducted in collaborations with the College of Veterinary Medicine, University of Tennessee. These studies were instrumental in the development of the laser light delivery balloon device for PDT, a critical element in improving treatment outcomes. Introduction of PDT for Barrett’s Esophagus replaced esophagectomy, which was the standard of care for patients with high grade dysplasia and early caner at that time. Esophagectomy is associated with a high rate of complications and mortality.
In addition, our partnership with scientists at the Oak Ridge National Laboratory resulted in the development of techniques for early detection of dysplasia and cancer in Barrett’s esophagus using a technique called Laser Induced Fluorescence (LIF) spectroscopy, also called optical biopsy.
Educational Services
Our center was a national training facility for treatment of Barrett’s esophagus and esophageal cancer where trainees learned the proper application of photodynamic therapy for Barrett’s esophagus. Our hands-on teaching laboratory located in the UT College of Veterinary Medicine was used to train physicians and nurses in an animal model. Medical personnel from many prestigious medical centers received training at our institution.
Patient education is strongly emphasized in our program via personal phone discussions between our patients, physicians and staff. An extensive array of brochures and other informative material is mailed to patients before they come for treatment. Prior to the procedure, the nurse and doctors contact the patient to discuss the treatments in detail. Ample opportunity is provided for the patients to ask questions.
Excellent Patient Satisfaction Scores
All patients are provided a satisfaction survey. They are asked to rate all aspects of their care and assign an overall satisfaction score of 1 to 10, with 10 being very satisfied. Our monthly average satisfaction scores are typically around 9.9.
These high satisfaction scores are the result of 36 years of clinical experience concentrating on treatment and follow-up of patients with Barrett’s esophagus.
Our Research Publications
Our staff participated in research studies to discover the most effective diagnostic and treatment methods for Barrett’s esophagus. We have lectured extensively at national conferences and have published 62 research papers and book chapters. Click here for complete list of our publications.
We have presented our research results at conferences such as the International Photodynamic Association, American College of Gastroenterology, Digestive Disease Week, American Society for Laser Medicine and Surgery and Photonics West meeting.
What Is Barrett’s Esophagus?
Barrett’s esophagus is a precancerous condition that develops in approximately 10% of patients who have gastroesophageal reflux disease (GERD). Patients with Barrett’s esophagus are 30-40 times more likely to develop esophageal cancer than the normal population.
In Barrett’s esophagus, the normal cells that line the esophagus called squamous cells turn into a type of cell called specialized columnar cells with intestinal metaplasia, or Barrett’s Esophagus.
Once the cells in the lining of the esophagus have turned into Barrett’s cells they will not revert back to normal. In about 5% of patients, the Barrett’s cells may develop abnormal changes called dysplasia. Over several years, the dysplasia may progress into adenocarcinoma (cancer) of esophagus if not treated.
How Is Barrett’s Esophagus Diagnosed?
The standard of care for diagnosis of Barrett’s is endoscopic biopsy surveillance and WATS 3D brushing to detect dysplasia and/or early cancer. We also provide Tissue Cypher genetic testing to Barrett’s patients to identify those at a high risk for developing esophageal cancer.
To do an endoscopy, your doctor gently guides a long, thin tube called an endoscope through the mouth and into the esophagus. The endoscope contains a camera and light that allows the doctor to see the lining of the esophagus and to remove a small tissue sample called a biopsy. The biopsy is then examined by a pathologist to see whether the normal squamous cells have been replaced with Barrett’s cells. WATS 3D brushing may also be performed during the same endoscopy procedure. Tissue Cypher genetic testing is also available to identify those patients who are at a higher risk for developing esophageal cancer.
Treatment Options for Barrett’s Esophagus
If Low Grade Dysplasia (LGD), High Grade Dysplasia (HGD) or early cancer (carcinoma in situ) is detected within the Barrett’s segment, different outpatient endoscopic treatment options are provided to patients depending on the stage of their disease.
Barrett’s Patients without dysplasia are not typically treated (unless at a high risk per genetic testing). They will have follow-up endoscopies performed frequently with biopsies and /or WATS 3D brushing to detect any progression to dysplasia or cancer.
Request to be Contacted
Our Barrett’s Esophagus Center of Excellence is committed to providing the very best care for our patients. If you would like scheduling assistance with one of our medical specialists, please fill out our form to request an appointment.