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Review
. 2022 Nov 11:10:goac068.
doi: 10.1093/gastro/goac068. eCollection 2022.

State-of-the-art management of dysplastic Barrett's esophagus

Kornpong Vantanasiri  1 , Prasad G Iyer  1
Affiliations
Review

State-of-the-art management of dysplastic Barrett's esophagus

Kornpong Vantanasiri et al. Gastroenterol Rep (Oxf). .

Abstract

Endoscopic eradication therapy (EET) has become a standard of care for treatment of dysplastic Barrett's esophagus (BE) and early Barrett's neoplasia. EET mainly consists of removal of any visible lesions via endoscopic resection and eradication of all remaining Barrett's mucosa using endoscopic ablation. Endoscopic mucosal resection and endoscopic submucosal dissection are the two available resection techniques. After complete resection of all visible lesions, it is crucial to perform endoscopic ablation to ensure complete eradication of the remaining Barrett's segment. Endoscopic ablation can be done either with thermal techniques, including radiofrequency ablation and argon plasma coagulation, or cryotherapy techniques. The primary end point of EET is achieving complete remission of intestinal metaplasia (CRIM) to decrease the risk of dysplastic recurrence after successful EET. After CRIM is achieved, a standardized endoscopic surveillance protocol needs to be implemented for early detection of BE recurrence.

Keywords: Barrett’s esophagus; endoscopic eradication therapy; endoscopic mucosal resection; endoscopic submucosal dissection; esophageal adenocarcinoma.

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Figures

Figure 1.
Figure 1.
Band-ligation EMR technique (band EMR). (A) Margins of the visible lesion are marked with electrocautery (optional). (B) Pseudopolyp is created after the deployment of pre-loaded rubber band. (C) The pseudopolyp is snared just below the rubber band. (D) Post-resection bed after complete removal of pseudopolyp.
Figure 2.
Figure 2.
Cap-and-snare EMR technique (cap EMR). (A) Visible lesion is identified. (B) The lesion is lifted using a submucosal injection. (C) The lesion is sucked into the cap and resected with the pre-looped snare using electrocautery. (D) Post-resection bed after complete removal of the lesion.
Figure 3.
Figure 3.
ESD technique. (A) Margins of the visible lesion are marked with electrocautery. (B) Submucosal injection is performed to lift the lesion from muscularis propria. (C) The lesion is circumferentially dissected using endoscopic knife. (D) Post-resection bed after complete removal of the lesion.
Figure 4.
Figure 4.
RFA technique using focal ablation device
Figure 5.
Figure 5.
RFA technique using balloon-based device. (A) Long circumferential BE segment is noted. (B) Inflated RFA balloon catheter in the esophageal lumen. (C) Post-ablation mucosa.
Figure 6.
Figure 6.
Cryoballoon ablation. Nitrous-oxide cryogen is delivered via a rotatable catheter and contained within the balloon, freezing the BE mucosa by surface contact.
See this image and copyright information in PMC

References

    1. Singh S, Manickam P, Amin AV. et al. Incidence of esophageal adenocarcinoma in Barrett's esophagus with low-grade dysplasia: a systematic review and meta-analysis. Gastrointest Endosc 2014;79:897–909.e4. quiz 83.e1–e3. - PubMed
    1. Rastogi A, Puli S, El-Serag HB. et al. Incidence of esophageal adenocarcinoma in patients with Barrett's esophagus and high-grade dysplasia: a meta-analysis. Gastrointest Endosc 2008;67:394–8. - PubMed
    1. American Gastroenterological A, Spechler SJ, Sharma P. et al.; American Gastroenterological Association. American Gastroenterological Association medical position statement on the management of Barrett's esophagus. Gastroenterology 2011;140:1084–91. - PubMed
    1. Phoa KN, van Vilsteren FG, Weusten BL. et al. Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia: a randomized clinical trial. JAMA 2014;311:1209–17. - PubMed
    1. Shaheen NJ, Sharma P, Overholt BF. et al. Radiofrequency ablation in Barrett's esophagus with dysplasia. N Engl J Med 2009;360:2277–88. - PubMed