[Diagnosis and therapy of early neoplasia in Barrett's esophagus]

There has been a dramatic increase in recent years in the incidence of Barrett's esophagus and the esophageal adenocarcinoma associated with it. Adequate monitoring strategies and improved diagnostic procedures are therefore essential. Alongside conventional video endoscopy with four-quadrant biopsies, many additional diagnostic procedures are now available to improve monitoring. These allow early diagnosis of dysplastic areas and early carcinomas. Endoscopic therapy has gained more and more importance in the treatment of early esophageal neoplasias over the last few years. Localized lesions in the Barrett's segment should be treated by endoscopic resection (ER). Only in patients with not localized or multifocal superficial lesions photodynamic therapy (PDT) should be used. Between the different ER techniques the "suck and cut"-technique with ligation device or cap should be favoured to normal strip biopsy in the esophagus because of the size of the resected specimen and its technical feasibility. ER of high grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett's esophagus should be considered as the treatment of choice. ER of early neoplasia in Barrett's esophagus is a safe and effective method but should only be performed by experienced endoscopists.