State of the Art: Management of Barrett’s Esophagus Related Dysplasia and Neoplasia—Which Patient and What Therapy?

Abstract

Endoscopic eradication therapy (EET) is safe and effective in the management of Barrett’s esophagus (BE) related dysplasia and early adenocarcinoma. EET includes endoscopic resection of the visible lesions followed by ablation to eradicate the residual Barrett’s epithelium. Techniques available for endoscopic resection include cap-based endoscopic mucosal resection and endoscopic submucosal dissection. Ablative therapies such as RFA, cryoablation and APC are used for the eradication of dysplastic BE and to prevent progression to EAC. Complete remission of intestinal metaplasia is the goal of EET. Post-treatment endoscopic surveillance is recommended to detect recurrence of metaplasia/dysplasia, mostly at the gastroesophageal junction.

Organ and function preservation in gastrointestinal cancer: Current and future perspectives on endoscopic ablation

“…Endoscopic ablation of dysplastic Barrett esophagus with radiofrequency ablation (RFA) (Figure 1 ) has been shown to have high rate of complete eradication of dysplasia and intestinal metaplasia, as well as a reduced risk of disease progression to adenocarcinoma[ 29 ]. Liquid nitrogen spray cryotherapy (LNSC) (Figure 2 ) and balloon cryotherapy (BC) (Figure 3 ) have been shown to eradicate dysplasia at rates of approximately 80%[ 30 ]. In patients with intramucosal adenocarcinoma related to Barrett, both RFA and LNSC were found to be effective[ 31 ].…”

The Importance of Community in Growing a Fledgling Journal

“…In a little over 2.5 years, we have gone from a concept of becoming an integrated journal to developing a multidisciplinary collaborative editorial group, to completing 8 issues. 1,2 We have covered a wide variety of foregut topics including Barrett’s esophagus, 3 GERD, 4,5 esophageal motility, 6 obesity, 7 hiatal hernias, 8 esophageal cancer, 9 and achalasia. 10…”

Pushing the boundaries of endoscopic management of early-stage esophageal adenocarcinoma: Caution is advisable!

“…1,2 Whereas esophagectomy was previously considered the mainstay of treatment for EAC, there has been a steady shift toward endoscopic therapy comprising endoscopic resection (ER) and ablation of early-stage EAC given comparable survival and decreased morbidity in comparison with surgical management. 3,4 National guidelines now recommend ER for management of intramucosal carcinoma (IMC) (ie, T1a EAC) with lowrisk histologic features for lymph node metastasis (LNM), ie, absence of lymphovascular invasion and poor differentiation, both of which have been shown to be poor prognostic factors. [5][6][7] The risk of LNM in IMC is estimated at approximately 2%.…”