Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2018; 10(9): 165-174
Published online Sep 16, 2018. doi: 10.4253/wjge.v10.i9.165
Endoscopic therapy for Barrett’s esophagus and early esophageal cancer: Where do we go from here?
Tavankit Singh, Madhusudhan R Sanaka, Prashanthi N Thota
Tavankit Singh, Madhusudhan R Sanaka, Prashanthi N Thota, Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH 44195, United States
Author contributions: All authors contributed to the conception and design, acquisition of data and drafting of manuscript; all authors approved the final version of the article, including the authorship list.
Conflict-of-interest statement: Authors deny any conflict-of-interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Prashanthi N Thota, MD, Staff Physician, Department of Gastroenterology and Hepatology, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States.
Telephone: +1-216-4440780 Fax: +1-216-4454222
Received: April 24, 2018
Peer-review started: April 24, 2018
First decision: June 8, 2018
Revised: June 13, 2018
Accepted: June 27, 2018
Article in press: June 28, 2018
Published online: September 16, 2018
Processing time: 146 Days and 14.5 Hours

Since Barrett’s esophagus is a precancerous condition, efforts have been made for its eradication by various ablative techniques. Initially, laser ablation was attempted in non-dysplastic Barrett’s esophagus and subsequently, endoscopic ablation using photodynamic therapy was used in Barrett’s patients with high-grade dysplasia who were poor surgical candidates. Since then, various ablative therapies have been developed with radiofrequency ablation having the best quality of evidence. Resection of dysplastic areas only without complete removal of entire Barrett’s segment is associated with high risk of developing metachronous neoplasia. Hence, the current standard of management for Barrett’s esophagus includes endoscopic mucosal resection of visible abnormalities followed by ablation to eradicate remaining Barrett’s epithelium. Although endoscopic therapy cannot address regional lymph node metastases, such nodal involvement is present in only 1% to 2% of patients with intramucosal adenocarcinoma in Barrett esophagus and therefore is useful in intramucosal cancers. Post ablation surveillance is recommended as recurrence of intestinal metaplasia and dysplasia have been reported. This review includes a discussion of the technique, efficacy and complication rate of currently available ablation techniques such as radiofrequency ablation, cryotherapy, argon plasma coagulation and photodynamic therapy as well as endoscopic mucosal resection. A brief discussion of the emerging technique, endoscopic submucosal dissection is also included.

Keywords: Endoscopic mucosal resection, Barrett’s esophagus, Dysplasia, Adenocarcinoma, Endoscopic therapy, Radiofrequency ablation

Core tip: Endoscopic treatment has become the standard of care for Barrett’s esophagus with dysplasia and/or early adenocarcinoma. The treatment primarily consists of resection of any visible lesions by either endoscopic mucosal resection or rarely, endoscopic submucosal dissection followed by ablation of metaplastic epithelium by one of the many available techniques (radiofrequency ablation being the most commonly used). While periodic surveillance is still required after complete eradication of intestinal metaplasia, these treatment modalities have proven to decrease the incidence of esophageal adenocarcinoma, improve the quality of life and are cost effective.