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Review
. 2022 Sep;51(3):485-500.
doi: 10.1016/j.gtc.2022.06.004. Epub 2022 Aug 30.

Management of Dysplastic Barrett's Esophagus and Early Esophageal Adenocarcinoma

Cary C Cotton  1 , Swathi Eluri  2 , Nicholas J Shaheen  3
Affiliations
Review

Management of Dysplastic Barrett's Esophagus and Early Esophageal Adenocarcinoma

Cary C Cotton et al. Gastroenterol Clin North Am. 2022 Sep.

Abstract

While patients with Barrett's esophagus without dysplasia may benefit from endoscopic surveillance, those with low-grade dysplasia may be managed with either endoscopic surveillance or endoscopic eradication. Patients with Barrett's esophagus with high-grade dysplasia and/or intramucosal adenocarcinoma will generally require endoscopic eradication therapy. The management of Barrett's esophagus with dysplasia and early esophageal adenocarcinoma is predominantly endoscopic, with multiple effective methods available for the resection of raised neoplasia and ablation of flat neoplasia. High-dose proton-pump inhibitor therapy is advised during the treatment of Barrett's esophagus with dysplasia and early esophageal adenocarcinoma. After the endoscopic eradication of Barrett's esophagus and associated neoplasia, surveillance is required for the diagnosis and retreatment of recurrence or progression.

Keywords: Adenocarcinoma; Barrett’s esophagus; Cryotherapy; Dysplasia; Endoscopic eradication therapy; Endoscopic mucosal resection; Radiofrequency ablation.

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Conflict of interest statement

Disclosure C.C. Cotton has no conflicts of interest. S. Eluri has no conflicts of interest. N.J. Shaheen has received research funding from Medtronic, Pentax, Steris, CDx Medical, Lucid, and Interpace Diagnostics and has worked as a consultant for Boston Scientific, Cernostics, Cook Medical, Aqua, Exact Sciences, and Phathom.

Figures

Figure 1.
Figure 1.
Key endoscopic landmarks in the endoscopic evaluation of Barrett’s esophagus.
Figure 2.
Figure 2.. Mucosal ablation devices commonly used in management of flat Barrett’s esophagus include (A) Barrx™ 360 Express, (B) Barrx™ 90, (C) C2™ cryoballoon, and (D) Trufreeze™ liquid nitrogen spray.
Courtesy of (A and B) Medtronic, Minneapolis, MN; (C) Pentax, Tokyo, Japan; (D) Steris, Mentor, OH; with permission.
Figure 2.
Figure 2.. Mucosal ablation devices commonly used in management of flat Barrett’s esophagus include (A) Barrx™ 360 Express, (B) Barrx™ 90, (C) C2™ cryoballoon, and (D) Trufreeze™ liquid nitrogen spray.
Courtesy of (A and B) Medtronic, Minneapolis, MN; (C) Pentax, Tokyo, Japan; (D) Steris, Mentor, OH; with permission.
Figure 2.
Figure 2.. Mucosal ablation devices commonly used in management of flat Barrett’s esophagus include (A) Barrx™ 360 Express, (B) Barrx™ 90, (C) C2™ cryoballoon, and (D) Trufreeze™ liquid nitrogen spray.
Courtesy of (A and B) Medtronic, Minneapolis, MN; (C) Pentax, Tokyo, Japan; (D) Steris, Mentor, OH; with permission.
Figure 2.
Figure 2.. Mucosal ablation devices commonly used in management of flat Barrett’s esophagus include (A) Barrx™ 360 Express, (B) Barrx™ 90, (C) C2™ cryoballoon, and (D) Trufreeze™ liquid nitrogen spray.
Courtesy of (A and B) Medtronic, Minneapolis, MN; (C) Pentax, Tokyo, Japan; (D) Steris, Mentor, OH; with permission.
Figure 3.
Figure 3.
In band-assisted endoscopic mucosal resection (A) a nodular lesion is carefully examined under white light and narrow-band imaging at the 11 o’clock position, (B) the perimeter is marked with a snare tip, the lesion is pulled into the endoscope cap using suction and (C) a band is deployed, the lesion is ensnared under the band, and (D) the lesion is resected en bloc by snare electrocautery.
Figure 3.
Figure 3.
In band-assisted endoscopic mucosal resection (A) a nodular lesion is carefully examined under white light and narrow-band imaging at the 11 o’clock position, (B) the perimeter is marked with a snare tip, the lesion is pulled into the endoscope cap using suction and (C) a band is deployed, the lesion is ensnared under the band, and (D) the lesion is resected en bloc by snare electrocautery.
Figure 3.
Figure 3.
In band-assisted endoscopic mucosal resection (A) a nodular lesion is carefully examined under white light and narrow-band imaging at the 11 o’clock position, (B) the perimeter is marked with a snare tip, the lesion is pulled into the endoscope cap using suction and (C) a band is deployed, the lesion is ensnared under the band, and (D) the lesion is resected en bloc by snare electrocautery.
Figure 3.
Figure 3.
In band-assisted endoscopic mucosal resection (A) a nodular lesion is carefully examined under white light and narrow-band imaging at the 11 o’clock position, (B) the perimeter is marked with a snare tip, the lesion is pulled into the endoscope cap using suction and (C) a band is deployed, the lesion is ensnared under the band, and (D) the lesion is resected en bloc by snare electrocautery.
Figure 4.
Figure 4.. In endoscopic submucosal dissection (A) a nodular lesion is carefully examined under white light and narrow-band imaging, (B) the perimeter is marked with a snare tip, the lesion is lifted by injection of methylene blue, (C) the lesion is excised en bloc by submucosal dissection, and (D) the lesion is pinned to Styrofoam marked to indicate the spatial orientation of the specimen
From Codipilly DC, Dhaliwal L, Oberoi M, et al. Comparative Outcomes of Cap Assisted Endoscopic Resection and Endoscopic Submucosal Dissection in Dysplastic Barrett’s Esophagus. Clin Gastroenterol Hepatol. 2022;20(1):65–73.e1; with permission.
Figure 4.
Figure 4.. In endoscopic submucosal dissection (A) a nodular lesion is carefully examined under white light and narrow-band imaging, (B) the perimeter is marked with a snare tip, the lesion is lifted by injection of methylene blue, (C) the lesion is excised en bloc by submucosal dissection, and (D) the lesion is pinned to Styrofoam marked to indicate the spatial orientation of the specimen
From Codipilly DC, Dhaliwal L, Oberoi M, et al. Comparative Outcomes of Cap Assisted Endoscopic Resection and Endoscopic Submucosal Dissection in Dysplastic Barrett’s Esophagus. Clin Gastroenterol Hepatol. 2022;20(1):65–73.e1; with permission.
Figure 4.
Figure 4.. In endoscopic submucosal dissection (A) a nodular lesion is carefully examined under white light and narrow-band imaging, (B) the perimeter is marked with a snare tip, the lesion is lifted by injection of methylene blue, (C) the lesion is excised en bloc by submucosal dissection, and (D) the lesion is pinned to Styrofoam marked to indicate the spatial orientation of the specimen
From Codipilly DC, Dhaliwal L, Oberoi M, et al. Comparative Outcomes of Cap Assisted Endoscopic Resection and Endoscopic Submucosal Dissection in Dysplastic Barrett’s Esophagus. Clin Gastroenterol Hepatol. 2022;20(1):65–73.e1; with permission.
Figure 4.
Figure 4.. In endoscopic submucosal dissection (A) a nodular lesion is carefully examined under white light and narrow-band imaging, (B) the perimeter is marked with a snare tip, the lesion is lifted by injection of methylene blue, (C) the lesion is excised en bloc by submucosal dissection, and (D) the lesion is pinned to Styrofoam marked to indicate the spatial orientation of the specimen
From Codipilly DC, Dhaliwal L, Oberoi M, et al. Comparative Outcomes of Cap Assisted Endoscopic Resection and Endoscopic Submucosal Dissection in Dysplastic Barrett’s Esophagus. Clin Gastroenterol Hepatol. 2022;20(1):65–73.e1; with permission.
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References

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