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Mucosal ablation of Barrett esophagus

Nature Reviews Gastroenterology & Hepatology volume 6, pages 393–401 (2009)Cite this article

A Correction to this article was published on 01 April 2010

Abstract

The management of Barrett esophagus is evolving with the emergence of new endoscopic technologies. Traditionally, patients with high-grade dysplasia or cancer were referred for esophagectomy. However, with the advent of endoscopic ablative therapies for Barrett esophagus, the treatment paradigm has shifted. Patients with high-grade dysplasia and intramucosal carcinoma are increasingly offered esophagus-sparing therapies. Endoscopic ablative therapies can be categorized into tissue-acquiring and non-tissue-acquiring modalities. Visible lesions in the setting of dysplasia should be treated with a tissue-acquiring modality to stage and resect the lesion appropriately. One or more modalities may be used to eradicate the entire region of affected esophagus totally. Total eradication treats all of the at-risk epithelium and, therefore, treats any metachronous or synchronous lesions. Success of treatment may be gauged by complete remission of cancer, dysplasia, or Barrett esophagus. In addition to procedure-related complications, the risk of residual Barrett esophagus or subsquamous Barrett esophagus remains to be addressed. Endoscopic surveillance and acid suppression is still currently required after ablation.

Key Points

  • Total eradication of Barrett esophagus provides treatment not only for known lesions, but also for metachronous and synchronous lesions in the remainder of the at-risk epithelium

  • Visible lesions in the setting of high-grade dysplasia or intramucosal carcinoma should be treated with a tissue-acquiring modality to stage and treat the lesion appropriately

  • Ablative therapies, such as photodynamic therapy, radiofrequency ablation and cryotherapy, hold promise for the treatment of Barrett esophagus

  • The diagnosis of neoplasia in Barrett esophagus should be confirmed by expert gastrointestinal pathologists

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Figure 1: Endoscopic mucosal resection of a lesion with use of the cap-assisted technique.
Figure 2: Treatment of Barrett esophagus by radiofrequency ablation.

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Acknowledgements

Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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  1. Center for Endoscopic Research and Therapeutics, Section of Gastroenterology, University of Chicago Medical Center, Chicago, IL, USA

    Irving Waxman & Vani J. A. Konda

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Correspondence to Irving Waxman.

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Waxman, I., Konda, V. Mucosal ablation of Barrett esophagus. Nat Rev Gastroenterol Hepatol 6, 393–401 (2009). https://doi.org/10.1038/nrgastro.2009.90

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