Critical Decision Making: Technical Aspects of Esophageal Ablation

Care for patients with dysplastic Barrett’s esophagus is rooted in endoscopic ablative therapies. Radiofrequency ablation (RFA), cryotherapy and argon plasma coagulation, in conjunction with endoscopic resection techniques and optimized pharmacologic and surgical therapy of reflux can lead to complete eradication when the appropriate ablative technology is used in the appropriate Barrett’s patient. This article reviews the critical decisions and technical considerations necessary to be successful in this aspect of Barrett’s care. Use of a cap device, optimal pre ablation preparation and technical aspects of RFA, cryotherapy and argon plasma coagulation are discussed. A detailed algorithm, that if followed, will greatly improve the opportunity for success is presented.