Optimal endoluminal treatment of Barrett’s esophagus: integrating novel strategies into clinical practice

Abstract

Endoluminal therapy has become the first-choice treatment over the last 5 years for early Barrett's neoplasia limited to the mucosa. Long-term follow-up data on endoscopic resection have demonstrated the oncological safety of endoscopic resection in comparison to surgery. However, there is a high rate of recurrent disease, which can be avoided using additional ablation of the remaining Barrett. Radiofrequency ablation was recently introduced as an efficacious means to ablate Barrett's epithelium with a better safety profile than older ablation techniques. Recent studies show that endoscopic resection can be safely combined with radiofrequency ablation for treating dysplastic Barrett's after removal of visible lesions. This constitutes a completely new treatment paradigm that will be integrated in routine clinical practice in the forthcoming years.

Diagnosis and Management of Barrett’s Esophagus with and Without Dysplasia

“…The most commonly used technologies currently are EMR and RFA, applied alone or in combination. Evidence for their efficacy has emerged rapidly over the past decade [151,[169][170][171]. The goal of endoscopic eradication therapy (EET) for BE patients, especially those with HGD or IMC is to complitelly eliminate all dysplastic and non-dysplastic Barrett's epithelium to get a complete reversion to normal squamous epithelium without islands of buried IM.…”

“…At now, EMR should be performed in BE patients who have dysplasia as macroscopically visible mucosal irregularities to determine the T stage of the neoplasia (151,(169)(170)(171)(172)(173)(174)(175). A large Endoscopy of GI Tractnumber of different techniques with or without suction or submucosal injection that raise the lesions can be used.…”

“…A large Endoscopy of GI Tractnumber of different techniques with or without suction or submucosal injection that raise the lesions can be used. EMR can be performed by the lift and snare technique, cap-assisted endoscopic resection, multiband mucosectomy, and Euroligator technique [169,170,[172][173][174][175]. Endoscopic submucosal dissection (ESD) is also used.…”

“…Five-year follow-up data for 231 BE patients with IMC demonstrated a 95.7% complete response rate [180]. Focal EMR is associated with high recurrence rate up to 47%, and increased with longer observation times, may be due to multifocal synchronous lesions previously missed by biopsy, as well as the metachronous development of new lesions [169][170][171][172][181][182][183][184]. Recent data suggests that the presence of submucosal invasion of occult adenocarcinoma in the setting of HGD was 6.7% -12%, which was much lower than previously reported [171,185].…”

“…This more aggressive method is also known as circumferential EMR, stepwise radical endoscopic resection (SRER), and wide area EMR. All of these techniques have proven to eradicate all Barrett's epithelium curatively and give possibility for a more accurate pathology result when compared to pre-EMR biosy results [169,170]. Complete eradication rate has observed from 76% to 100%, and recurrence of malignancy in up to 11%, without association with BE tissue recurrence [189,196,198,[200][201][202].…”