Management of Dysplastic Barrett’s Esophagus and Early Esophageal Adenocarcinoma

Endoscopic Management of Dysplastic Barrett’s Oesophagus and Early Oesophageal Adenocarcinoma

“…Compared to surgery, ER appears effective for patients with dysplastic BO and early T1a OAC with a better safety profile [20]. In a meta-analysis of 7 studies that included 870 patients with HGD or T1a OAC, there was no significant difference in neoplastic remission or overall survival between surgery and endotherapy (ER and ablation).…”

“…The most straightforward landmark to define the GOJ, and the recommended minimum requirement, is the proximal limit of the longitudinal stomach folds with minimal air insufflation [18,19]. Thus, the initial endoscopic diagnosis of BO can be carried out when the endoscopist detects the presence of ≥1 centimetre of salmoncoloured mucosa extending proximally beyond the GOJ on the top of the gastric folds [20]. The use of incorrect landmarks for the GOJ can lead to a misclassification of BO, with a negative impact on the early diagnosis of neoplasia [21].…”

“…The band-ligation technique involves the release of an elastic band at the bottom of the lesion, which generates a pseudopolyp that can then be resected by a hot snare (Figure 2). The efficacy of both EMR techniques is comparable, although band-ligation is most commonly performed given its comparable ease and shorter time [20]. A comparative study between the two techniques has shown no significant differences in the maximum diameter of the resected specimen (approximately 16 × 11 mm for band-ligation versus 15 × 10 mm for cap-snare) nor any differences in the maximum diameter of the resected ulcer base after 24 h (approximately 21 × 14 mm for band-ligation versus 19 × 13 mm for cap-snare).…”

“…This technique is particularly useful for the resection of large oesophageal lesions. Indeed, a higher percentage of en-bloc resections and subsequent lower rates of recurrence have been reported with ESD over traditional EMR [20,54].…”