Esophageal Disease and Treatments at Columbia University Medical Center

Our thoracic surgeons have wide experience in the management of benign and malignant esophageal disease. The epidemiology of esophageal cancer has changed dramatically over the past decade. The incidence of adenocarcinoma associated with Barrett's metaplasia is rising dramatically, faster than any other tumor in North America. Squamous cell cancer of the esophagus continues to afflict nearly 10,000 Americans annually.

Surgical resection from cancer of the esophagus offers patients immediate relief of symptoms and potential for cure. In the past, these tumors were often advanced when diagnosed and recurrence was not uncommon. In recent years, we have employed a multimodality approach to cancer of the esophagus.

The combination of chemotherapy and radiotherapy prior to surgery has dramatically improved both resectability and survival. A unique aspect of our approach to esophageal cancer involves endoscopic transesophageal ultrasound (EUS) to visualize tumor depth, surrounding lymph nodes and relationships to adjacent structures. This advanced technique is noninvasive, reliable and reproducible. In combination with PET and CT scanning, EUS is highly effective in properly staging tumors of the esophagus, thereby permitting better therapeutic decision-making for our patients with esophageal tumors.

At CUMC, patients with esophageal motor disorders undergo careful radiographic, manometric and motility studies. Following appropriate diagnostic evaluation, if surgery is required, individualized treatment can be selected from a variety of open, minimally invasive or closed therapeutic options.

Gastroesophageal Reflux Disease (GERD) and its Treatments

Heartburn, also known as gastroesophageal reflux (GERD), afflicts millions of Americans. Most patients respond well to conservative measures including dietary modification, weight loss and antacid therapy; however, lasting control of symptoms may not be attained.

For those patients in whom a medical regimen has not been successful, anti-reflux surgery, employing a variety of fundoplication procedures, can offer gratifying, durable results with relief of GERD and discontinuation of expensive medical regimens. In appropriately selected patients, minimally invasive surgical techniques have significantly reduced hospitalization days and convalescence.