The controversy regarding ablation for Barrett's esophagus without dysplasia

Abstract

Purpose of review: This article discusses the various management options and gaps in knowledge in our current understanding of the epidemiology and neoplastic progression of Barrett's esophagus and how this affects the decision to treat patients with nondysplastic Barrett's esophagus (NDBE).

Recent findings: Barrett's esophagus is the only known risk factor for esophageal adenocarcinoma (EAC), the most rapidly rising cancer in terms of incidence in the United States. The current management strategy is to enroll patients with Barrett's esophagus in surveillance programs. Despite these efforts, the incidence of EAC has continued to rise. Recent studies have shown endoscopic ablation therapies to be relatively safe and effective in the eradication of NDBE. However, all studies performed to date were cohort in nature with no randomized controlled trial data available at this time. At present, several critical questions remain unanswered: Will treatment of NDBE eliminate the risk of developing cancer? If not, just how effective is the treatment? Is it durable? Can surveillance be stopped after ablation? What are the risks? Would such treatment be cost-effective?

Summary: It is possible that if future data can affirmatively answer some of these questions, ablation of NDBE would be reasonable in selected patients; however, until then, a wait and watch approach is likely to be the best option for most low-risk patients.