Endoscopic eradication therapies for Barrett’s esophagus

Abstract

Gastroesophageal reflux disease along with its end stage manifestations such as intestinal metaplasia, dysplasia, and neoplasia have become increasingly prevalent in the United States and Western countries. Intestinal metaplasia, or Barrett’s Esophagus (BE), is a well described pre-malignant entity that can progress to esophageal adenocarcinoma. While esophageal adenocarcinoma is challenging to treat, early stage disease can still be cured with esophagectomy and perioperative chemoradiation therapy. Despite multimodality therapy, recurrence rates remain high even for early stage disease. Surveillance endoscopy of patients with BE may identify dysplastic changes or carcinoma in-situ prior to the development of invasive cancer. Endoscopic eradication therapies are a low-risk approach to treat dysplastic lesions and non-dysplastic lesions in high-risk patients to subvert progression to adenocarcinoma. Endoscopic mucosal resection (EMR), radiofrequency ablation (RFA), and cryotherapy are current endoscopic therapies that are safe and effective in the management of BE.