Advances in the management of Barrett's esophagus and early esophageal adenocarcinoma

Abstract

The incidence of esophageal adenocarcinoma (EAC) has markedly increased in the United States over the last few decades. Barrett's esophagus (BE) is the most significant known risk factor for this malignancy. Theoretically, screening and treating early BE should help prevent EAC but the exact incidence of BE and its progression to EAC is not entirely known and cost-effectiveness studies for Barrett's screening are lacking. Over the last few years, there have been major advances in our understanding of the epidemiology, pathogenesis and endoscopic management of BE. These developments focus on early recognition of advanced histology and endoscopic treatment of high-grade dysplasia. Advanced resection techniques now enable us to endoscopically treat early esophageal cancer. In this review, we will discuss these recent advances in diagnosis and treatment of Barrett's esophagus and early esophageal adenocarcinoma.

Keywords: Barrett’s esophagus; early esophageal adenocarcinoma; endoscopy.

Figure 1.

Radiofrequency ablation (RFA) of Barrett’s esophagus. (A) A 62 year-old male patient with a short segment of Barrett’s esophagus and flat high-grade dysplasia. (B) Residual Barrett’s segment after a single session of circumferential RFA treatment. (C) Focal RFA of the residual Barrett’s segment.

Figure 2.

Hybrid therapy for Barrett’s esophagus. (A) A 71-year-old male with long-segment Barrett’s esophagus (Prague C8M9). (B) Circumferential radiofrequency ablation (RFA) using a balloon RFA catheter was performed. (C and D) Repeat endoscopy at 6 months after two sessions of RFA showed neosquamous epithelium and a small nodule (arrows). (E) Successful endoscopic mucosal resection (EMR) of the nodule was performed using a band ligation and snare resection technique, after injecting with indigocarmine. (F) The mucosal defect after resection showed intact submucosa stained with indigocarmine. Focal RFA of the residual Barrett’s was also performed at this session.

Figure 3.

Endoscopic mucosal resection (EMR) for early esophageal adenocarcinoma. (A) A nodular lesion with central depression causing concern about malignancy at the proximal end of Barrett’s segment. (B) The lesion lifted well with submucosal injection. (C and D) EMR was successfully performed using band ligation. The pathology showed intramucosal cancer (T1a) without any involvement of the deep and lateral margins.