Endoscopic therapy of Barrett's esophagus

Endoscopic therapy for early neoplasia arising in Barrett's esophagus has gained wide acceptance in the USA and Europe, and long-term results of endoscopic resection and photodynamic therapy and new ablation techniques are available now. This review summarizes the different indications for endoscopic treatment and the recent data on the different endoscopic treatment techniques.

Endoscopic treatment of high-grade intraepithelial neoplasia has proven to be well tolerated and effective even after a long-term follow-up of more than 5 years. Radiofrequency treatment seems to be an effective technique for ablation of Barrett's esophagus with low and high-grade intraepithelial neoplasia on short-term follow-up with a very low complication rate. Recent data were able to demonstrate that biomarkers can predict the treatment effect of photodynamic therapy and several risk factors for stricture formation after treatment could be identified.

Endoscopic therapy of early Barrett's neoplasia has proven to be well tolerated and effective and can be considered as the treatment of choice for most patients with this disease. Visible lesions should be treated by endoscopic resection in order to obtain a specimen for histological work up. The remaining nondysplastic Barrett's epithelium after complete resection of all neoplastic lesions should be ablated, for example, by radiofrequency treatment, to prevent metachronous or recurrent neoplasia.