Endoscopic Diagnosis and Management of Barrett's Esophagus with Low-Grade Dysplasia

Abstract

Barrett's Esophagus is a common condition associated with chronic gastroesophageal reflux disease. It is well known that it has an association with a higher incidence of esophageal adenocarcinoma, but this neoplastic transformation is first preceded by the onset of low and high-grade dysplasia. The evaluation of low grade dysplastic esophageal mucosa is still controversial; although endoscopic surveillance is preferred, several minimally invasive endoscopic therapeutic approaches are available. Endoscopic mucosal resection and radiofrequency ablation are the most used endoscopic treatments for the eradication of low-grade dysplasia, respectively, for nodular and flat dysplasia. Novel endoscopic treatments are cryotherapy ablation and argon plasma coagulation, that have good rates of eradication with less complications and post-procedural pain.

Keywords: Barrett’s esophagus; cryotherapy; endoscopic mucosal resection; endoscopy; low-grade dysplasia; radiofrequency ablation.

Figure 1

Gastroesophageal junction in Barrett’s Esophagus; (a) Segmental Barrett’s Esophagus (b) Circumferential Barrett’s esophagus.

Figure 2

Endoscopic evaluation of circumferential Barrett’s Esophagus (a) in white light endoscopy; (b) in narrow band imaging vision (NBI).