What are the available surgical (endoscopic) treatment options in patients with Barrett esophagus?
Janusz Jankowski, MD, PhD: That is very important to emphasize. If you are talking about surgery, we do not often offer Nissen fundoplication at that stage. We offer that only for severe reflux disease, but that should not be offered for Barrett esophagus per se. There is no evidence that it prevents cancer risk other than what you would do for the reflux disease.
Secondly, [we offer] none of the endotherapies to tighten up the sphincter, so the different endoscopic mechanisms that can enhance the lower esophageal sphincter. We do not recommend that because in fact none of them are more effective than proton pump inhibitors, and some of them are more costly and have more complications.
What we do offer is endotherapy for people with dysplastic Barrett esophagus. The 3 forms of treatment that have the best testing are argon laser beam therapy, radiofrequency ablation, and endoscopic mucosal resection by surgical resection with the use of a lasso.