Oesophagopharyngeal

Question 1

What is the treatment pathway for Barrett’s oesophagus?

Answer 1

1. Symptom control of GORD: PPI prescription and OTC alginates/antacids
   - avoid trigger foods
   - smaller meals
   - stop smoking
   - reduce alcohol
   - bed head elevation
   - review medications for exacerbating drugs (lots of kinds e.g. beta-blockers, CCBs, CS)
2. Long term endoscopic surveillance (for non-dysplasic):
   - <3cm = endoscopy every 3-5 years
   - >3cm = endoscopy every 2-3 years
3. If low-grade dysplasic: p53 immunostain and repeat endoscopy in 6 months
4. Potential photodynamic therapy, laser ablation or cryotherapy to treat any mildly dysplasic lesions confirmed at repeat 6 month endoscopy
5. For high grade dysplasia: Endoscopic mucosal resection

Question 2

What is the treatment pathway for oesophageal cancer?

Answer 2

After diagnosis:
1. CT or PET along with biopsy - staging and grading

2.If metastatic or stage T4 = Palliative (stenting or PEG/PEJ)
If potentially resectable = Endoscopic ultrasound

3. Stage 1/2 with no nodal spread = immediate surgery
   Stage 1/2 with nodal spread or stage 3 = preop chemo (shrink a T3) and then surgical re-evaluation
4. Often nutritional support is needed because of malnutrition caused by oesophageal obstruction (stent, NG tube, PEG)
5. Open or laparoscopic surgery
6. Nutritional support: Pre-surgery, inpatient and outpatient (after discharge to recover)- dietary assistance