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Technology Insight: ablative techniques for Barrett's esophagus—current and emerging trends

Nature Clinical Practice Gastroenterology & Hepatology volume 2, pages 323–330 (2005)Cite this article

Abstract

New mucosal ablative techniques that can be used in the esophagus have emerged over the past two decades. These techniques have been developed primarily to treat the precursors of esophageal adenocarcinoma: dysplasia in Barrett's esophagus and early esophageal cancer. Although high-grade dysplasia and early stage cancer can be treated with esophagectomy, the inherent morbidity and mortality of esophageal adenocarcinoma and the morbidities, difficulties, costs and limitations of the current technology mean that there has been a significant increase in interest and research regarding alternative treatments such as ablative techniques. At this stage it is not clear which of the numerous endoscopic ablative techniques available—photodynamic therapy, laser therapy, multipolar electrocoagulation, argon plasma coagulation, endoscopic mucosal resection, radiofrequency ablation or cryotherapy—will emerge as superior. In addition, it has yet to be determined whether the risks associated with ablation therapy are less than the risk of Barrett's esophagus progressing to cancer. Whether ablation therapy eliminates or significantly reduces the risk of cancer, eliminates the need for surveillance endoscopy, or is cost-effective, also remains to be seen. Comparative trials that are now underway should help to answer these questions.

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Figure 1: A 'tongue' of Barrett's esophagus pre-cryoablation.
Figure 2: A post-cryoablation image of Barrett's esophagus stained with Lugol's iodine.

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Authors and Affiliations

  1. Associate Professor of Medicine and Chief of the Gastroenterology and Colon Cancer Center at the National Naval Medical Center, Bethesda, MD, USA

    Mark H Johnston

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  1. Mark H Johnston
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Correspondence to Mark H Johnston.

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Competing interests

Research at the author's institution was funded through a Cooperative Research and Development Agreement (CRADA) between CryMed Technologies and that National Naval Medical Center. The author has served as a medical consultant to CryoMed Technologies.

Glossary

BLENDED ELECTROSURGICAL CURRENT

A combination of cutting and coagulating current; current delivered by electrocautery devices can be set at pure cut, pure coagulation or a combination of both

MACROSCOPIC TYPE LESIONS

Endoscopic staging of lesions as type I (polypoid), IIA (flat elevated), IIB (flat), IIC (depressed), IIA+C (flat elevated and depressed), and III (ulcerated)

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Johnston, M. Technology Insight: ablative techniques for Barrett's esophagus—current and emerging trends. Nat Rev Gastroenterol Hepatol 2, 323–330 (2005). https://doi.org/10.1038/ncpgasthep0214

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