Neil R. Sharma MD on What Patients Need to Know About Barrett Esophagus

Spray Cryotherapy Creates New Treatment Possibility for Barrett’s, Neil R. Sharma MD Says

Neil R. Sharma MD  is the Director of Advanced Interventional Endoscopy, Endoscopic Oncology, and Surgical Endoscopy (IOSE) Programs at Parkview Hospital in Fort Wayne, Indiana. He is also Medical Director of their GI Oncology Program, President of the Parkview Cancer Institute, and Assistant Professor of Medicine at Indiana University.

Dr. Neil Sharma is an authority on the use of a technique called spray cryotherapy to treat Barrett esophagus (also known as Barrett’s), a condition that is believed to affect as many as 3 million people in the United States alone and about 20 percent of people who suffer from acid reflux or GERD. A small number of cases of Barrett esophagus (about 0.5 percent per year) progress to adenocarcinoma of the esophagus, so monitoring and intervention are essential. As our understanding of Barrett’s increases. Dr. Neil R. Sharma says the medical profession has found that all genders, ages, and races can develop the disease.

Cryoablation may also be used for the treatment of esophageal cancer. Dr. Sharma has publications and ongoing clinical trials on its utilization for this application.

A technique called spray cryotherapy (also known as spray cryoablation), Dr. Sharma advises his colleagues, opens new possibilities for treating Barrett’s. But before we get into the details of this technique, a quick explanation of Barrett’s esophagus may be helpful.

What Is Barrett Esophagus?

In 1950, an Australian thoracic surgeon named Norman Barrett published a paper stating that stomach ulcers could be drawn up into the esophagus by scar tissue. It turned out he was wrong about the origins of this condition, but his contributions to treatment were such that the condition was named for him anyway.

Barrett’s esophagus is a condition in which the normally pink, flat, soft lining of the tube that connects the mouth to the stomach, the esophagus, becomes red, rough, and thickened. The damage to the esophagus in Barrett’s esophagus results from repeated exposure to stomach acid caused by acid reflux.

The classic presentation of a Barrett’s patient is a 50-something male who has a history of heartburn, acid reflux, and difficulty swallowing. Some Barrett esophagus patients, however, have no prior symptoms at all. 

This condition is usually diagnosed with a procedure called esophagogastroduodenoscopy, or EGD. It must be confirmed by a biopsy finding specialized intestinal metaplasia (SIM), precancerous cells in the esophagus. The biopsy and EGD are done at the same time.

Patients are put on restricted diets to reduce reflux. They will usually be prescribed a medication called a proton pump inhibitor (PPI). They may receive endoscopic therapy, radiofrequency ablation, or a kind of surgery known as endoscopic mucosal resection or EMR. But some patients are candidates for spray cryotherapy.

Neil R. Sharma MD Explains the Benefits of Spray Cryotherapy

Spray cryotherapy, Dr. Neil R. Sharma explains, uses liquid nitrogen as the cryogenic agent. When liquid nitrogen is applied to tissues, it causes cell death by the formation of ice crystals inside and outside each cell, pulling in destructive free radicals of oxygen as they thaw. Unlike heat treatments, liquid nitrogen preserves the connective tissues around the treated mucosal lining so it can regrow in place and resume its normal function.’

Liquid nitrogen treatment has one other advantage over heat treatment. Thawed cells can still be examined by the pathology lab, while heated cells cannot. The pathology lab can look at a biopsy and determine the degree to which precancerous and cancerous cells have been killed by the procedure.

“There is more long-term data on radiofrequency ablation. ” Dr. Sharma advises. “Early data shows the two modalities may be equally effective. Not having to come off blood thinners and less pain are considerations for the use of cryoablation. More studies are needed and being conducted so we can advance the science and improve patient care.”

“But when we ablate individuals with cryotherapy,” Dr. Neil R. Sharma says, “they usually feel pretty good. They don’t get the burning sensations and chest pain that they might get with other ablative therapies or with radiation. They really have no complaints.” Patients receiving spray cryotherapy, says Neil R. Sharma, MD., recover faster and feel better.