The clinical team at MedStar Georgetown University Hospital Department of Gastroenterology is well-known for esophageal expertise.
The esophagus is a muscular tube made of several layers of tissue, muscle, and membranes. It connects the throat to the stomach, serving as a passageway for food, drink, and saliva. Our gastroenterology specialists offer advanced diagnostic tests and minimally invasive surgical techniques. No matter the complexity or severity of your esophageal condition, our team is here to help.
Types of esophageal treatments
- Radiofrequency ablation
- Endoscopic ultrasound for staging of cancer
- Endoscopic mucosal resection
- Esophageal stenting
- Endoscopic Submucosal Dissection
- GERD care
- Esophageal Motility/ dysphagia/ swallowing disorders care
- Diverticulectomy/ myotomy
- Esophageal stricture care
- Eosinophilic esophagitis care
Endoscopic Mucosal Resection (EMR) is used to diagnose or treat pre-cancerous lesions or early cancer of the esophagus.
The procedure is performed by inserting a long, thin tube called an endoscope into the esophagus via the mouth. The endoscope is equipped with a camera, lights, and specialized surgical tools. The physician using the tools to remove small pieces of tissue. Sometimes, this procedure is done to collect samples for testing (biopsy). In other cases, it is used to entirely remove cancerous tissue.
Patients are typically put under anesthesia for an EMR procedure. For most patients, this procedure can be performed on an out-patient basis and they can return home the same day. Your doctor may prescribe medication to take after the surgery. You may also be asked to follow a modified diet during your recovery.
The esophageal tube can sometimes become tight or narrowed, a problem called esophageal stricture. Esophageal stricture is associated with motility disorders, eosinophilic esophagitis, and hernias. It can also be a side effect of scar tissue forming after esophageal surgeries. Strictures can make it difficult to swallow food or liquid and presents a risk of aspiration.
Stenting is one treatment option for esophageal stricture. During this procedure, patients are placed under general or local anesthesia. The physician inserts a folded-up stent (tube) into the esophagus. Once inside the esophagus, the stent is widened. It remains in place temporarily or permanently to support the esophagus.
Esophageal stenting is typically an outpatient procedure and most patients can return home the same day. Your doctor may prescribe medications to take after the surgery or advise you to take over-the-counter painkillers if you need them. You may also be asked to follow a modified diet during your recovery.
The esophagus is made of several layers of tissue, muscle, and membranes. When a patient has a tumor that has not spread to the muscle layer, Endoscopic Submucosal Dissection (ESD) is a potential treatment option.
During an ESD procedure, the physician inserts a long, thin tube called an endoscope into the esophagus via the mouth. The endoscope is equipped with a camera, lights, and specialized surgical tools. The physician uses the tools to remove a tumor in one piece, bringing the tumor up out of the body through the mouth. This precise and innovative procedure reduces the risk of leaving behind any diseased tissue.
Patients are typically put under anesthesia for an ESD procedure. Some patients undergo this procedure on an outpatient basis, and others are admitted to the hospital for post-surgical care. Your doctor may prescribe medication or recommend a modified diet after the surgery.
GERD is a severe, chronic acid reflux condition in which acidic stomach contents back up into your esophagus. GERD can often we treated with medication and/or lifestyle changes, but some patients may require surgical intervention.
Both over-the-counter and prescription medications are available for GERD. These medications may neutralize stomach acid (antacids) or reduce acid production (H-2 receptor blockers and proton pump inhibitors).
Patients with GERD can benefit from dietary changes, such as avoiding spicy, acidic, or fatty foods and alcoholic drinks. Eating smaller meals and avoiding eating before lying down, bending over, or exercising can also help.
Surgery is an option for patients whose symptoms do not respond to other treatments. Surgical options include:
- Fundoplication, a minimally invasive procedure in which the top of the stomach is wrapped around the bottom of the esophagus to tighten the muscle. Fundoplication is minimally invasive and can often be performed as an outpatient procedure.
- Placement of a LINX® Reflux Management System, a ring of small magnetic beads that help regulate the opening of the stomach into the esophagus. This procedure is minimally invasive and outpatient.
Esophageal motility disorders or difficulty swallowing (dysphagia) is often caused by a condition called achalasia, in which the esophageal muscles are overly tight. This is the most treatable cause of a swallowing disorder. Treatment options include:
- Peroral endoscopic myotomy (POEM): POEM is one of the newest treatment for achalasia and some other esophageal motility disorders. During the POEM procedure, patients are put under general sedation. Then, the clinician inserts a long, thin tube called an endoscope into the esophagus through the mouth. The physician inserts tools through the endoscope and makes tiny incisions in stiff esophageal tissues.
- Pneumatic dilation: This endoscopic therapy can be used to loosen tight esophageal muscles. The physician inserts a catheter into the mouth and down to the esophagus. Then, a small, deflated balloon is inserted and inflated. This process disrupts overly-tight esophageal muscle fibers. This procedure is typically outpatient.
- Heller myotomy: This minimally-invasive surgical procedure is designed to loosen an overly-tight esophageal passage. While the patient is under sedation, the physician inserts a thin, hollow tube into the mouth and down to the esophagus. Tiny surgical instruments are inserted through the tube and the physician makes small incisions on the outer layer of esophageal tissue. A Heller myotomy is performed as an inpatient procedure.
A diverticulum is a small pouch that can form in a weakened area of an organ. This weakness is typically the result of excess pressure. One of the most common types of esophageal diverticula is called a Zenker’s Diverticulum. This condition presents a risk of infection, inflammation, aspiration, and pneumonia.
A Zenker’s Diverticulum can be surgically treated through a diverticulectomy and/or incised by a myotomy.
- During a diverticulectomy, the pouch is removed or reduced in size. Typically, this is performed with a minimally-invasive, endoscopic approach. The physician inserts a long, thin tube called an endoscope through the mouth and into the esophagus. Then, the pouch is closed off using a stapling device.
- A myotomy procedure is typically performed using a minimally-invasive, endoscopic technique. During this procedure, the muscular ring at the top of the esophagus is cut to relieve excess pressure.
A diverticulectomy and/or myotomy require general anesthesia. Your doctor may prescribe medication or recommend a modified diet after the surgery.
Esophageal stricture is a term for the tightening or narrowing of the esophagus. When a stricture requires treatment, there are several options available. Treatments include:
- Esophageal stenting
- Dilation: Dilation is an endoscopic procedure that allows for the esophagus to be stretched. During this procedure, a long, thin tube called an endoscope is inserted into the esophagus through the mouth. Then, the esophagus is widened. Typically, this is done by inflating a small balloon in the esophageal passage. Dilation is an outpatient procedure.
- A self-dilation program: Some patients may be eligible for a self-dilation program, in which they are trained to a periodic, at-home process in order to keep the esophagus from tightening.
- Electrocautery: Electrocautery is procedure that uses heat generated by electricity to remove excess tissues. This procedure is completed endoscopically and is typically performed as an outpatient procedure.
Eosinophilic esophagitis is a condition in which the esophagus chronically swells due to a build-up of white blood cells. It is caused by an allergic/immune reaction.
Eosinophilic esophagitis can sometimes be treated with medication. Steroids and antireflux drugs can help to reduce inflammation and return the esophagus to a healthy state.
When medication is not effective, eosinophilic esophagitis can also be treated with dilation. Dilation is an endoscopic procedure that allows for the esophagus to be stretched. During this procedure, a long, thin tube called an endoscope is inserted into the esophagus through the mouth. Then, the esophagus is widened. Typically, this is done by inflating a small balloon in the esophageal passage. Dilation is an outpatient procedure.