Endoscopy Advice

[Cindy-S]

  My mother was diagnosed with Barrett's Disease about a year ago.  She also has Alzheimer's, I think she's in stage two.  She is scheduled for diagnostic endoscopy's once a year to check for esophageal cancer.  The endocronologist she was seeing left and she has a new one.  She is scheduled for her next endoscopy in about a week, but her new endocronologist told us he doesn't want to do it if we won't allow him to do surgery if he finds cancer.  He really didn't give us an explanation as to what surgery would involve and what impact it would have on her life.  I've read some of your responses and see there are alternatives to surgery.  It seems like it depends on the situation as to what the best treatment is.  In particular I was intrigued by the laser surgery and wondered how effective it has proven to be and what the survival rates tend to be as opposed to surgery if the cancer is caught early.  Unfortunately, in my mother's case symptoms are hard to come by with her Alzheimer's though she frequently complains of chest pains.  I think that's how they found the Barrett's disease to begin with.  She's also seeing a cardiologist who feels she may have had a slight heart attack in the past year or has some blockage.  She's taking a number of medications between the Alzheimer's, Barrett's disease and possible heart trouble.  I guess my main concern is the new endocronologist's attitude.  I'd appreciate any comments/suggestions that you have.  
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Dear Cindy S,
Thank you for your questions regarding Barrett’s esopahgus, a premalignant condition. Screening endoscopy is done to identify premalignant changes in the esophageal mucosa, that is to identify abnormal cells before a cancer develops.  When premalignant abnormalities are seen, the physician will suggest that the abnormality be removed.  This approach is based on the clinical observation that once esophageal cancer develops, death usually occurs within 1-2 years.
Surgical resection has been the conventional treatment for the premalignant lesions of Barrett’s esophagus, assumimg that the patient is a good surgical canditate.  However, there are other options now.  Specifically, the use of PDT therapy with laser has been shown to eliminate the premalignant condition.
I do not know your mother’s age or any information regarding her general medical condition, except for the Alzheimer’s disease.  Hopefully, your mother will not develop any premalignant changes.  If she does develop abnormalities, endoscopic laser therapy would be valuable, although several treatments may be necessary.  If you believe that you do not want to do any therapy (surgery or laser) should premalignant conditions be identified, then you should consider discontinuing the annual screening studies because they do not add any value to your mother’s care.
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician. If you wish to be seen at our institution, Henry Ford Hospital, please call our PHYSICIAN REFERRAL LINE at(313) 876-2393 and request consultation with Dr. Webb, one of our experts in Barrett’s esopahgus and photodynamic therapy.
HFHSM.D.-rf
*keywords: esophageal cancer, Barrett’s esophagus
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