Review: Endoluminal treatment of Barrett’s esophagus: current and future prospects

Abstract

Endoluminal treatment of Barrett's esophagus has become the preferred option for initial intervention for advanced neoplasia without invasive carcinoma. Data from abstracts presented at Digestive Disease Week 2008 provide greater insight into optimal use of existing techniques and an early look at potential next generation therapies. Results from the AIM Dysplasia trial describe a larger study with longer post-treatment surveillance highlighting the efficacy and tolerability of radiofrequency ablation, while early results from liquid nitrogen cryotherapy studies suggest a potential to obtain similar eradication results with very high tolerability. Endoscopic resection, despite its risks, remains a popular option for focal as well as more widespread resection of Barrett's mucosa. Additional abstracts highlight novel approaches to ablation and resection. Enhanced imaging techniques and molecular marker analysis also appear to improve treatment outcomes. However, time and further studies of combined approaches to diagnosis and eradication are necessary to optimize treatment algorithms. Keywords: Barrett's esophagus, esophageal cancer, therapeuticsIntroduction The rapid rise in the incidence of Barrett's esophagus over the past three decades has generated a great deal of interest regarding the optimal approach to management of this condition, where specialized intestinal metaplasia (SIM) with malignant potential replaces the normal esophageal squamous epithelium. With discovery of and subsequent improvements to endoluminal techniques for the removal of SIM, attention has focused on how and when to select an endoluminal therapy to eradicate the Barrett's esophagus. Previously [Smith and Lightdale, 2008], we described the variety of endoluminal alternatives available for treatment of Barrett's esophagus. In this article, and in advance of Digestive Disease Week 2009, we discuss some of the over 200 related abstracts presented at DDW 2008, with a particular focus on those which supplement our previous review of the use of endoscopic-based therapies for SIM.