A narrative review of endoscopic therapy for Barrett’s esophagus

Abstract

: Endoscopic therapy is recommended as the first line treatment for Barrett’s esophagus (BE) with high-grade dysplasia, low-grade dysplasia or BE with nodular lesions. Historically, open or laparoscopic surgery was the only option that could be offered to patients with the above conditions. Although it seemed the logical option, Esophagectomy is associated with increased morbidity and mortality as well as significant lifestyle modifications. Appropriately selecting patients for endoscopic therapy ensures curative resection, better survival, improved quality of life following the procedure and decrease risk of future recurrence. To review recent evidence and approaches for endoscopic treatment of Barrett’s esophagus. Selecting the best approach is tailored to the lesion, If BE is flat, ablation using radiofrequency ablation or cryoablation is indicated. In case of nodular BE, endoscopic resection using endoscopic mucosal resection or endoscopic submucosal dissection should be performed first, based on lesion size and available expertise. Following endoscopic resection, ablation of the remaining flat epithelium is indicated to ensure complete remission of BE. Data regarding training and quality benchmarks for ESD in the management of esophageal adenocarcinoma and Barrett’s esophagus is needed. Combining ESD with other modalities in the management of early esophageal adenocarcinoma extending to the submucosa (T1b) needs to be explored.