Endoscopic ablation therapy of Barrett's esophagus

Barrett's esophagus (BE) is an important risk factor for esophageal carcinoma and its incidence is rising. Amongst the various available endoscopic ablative therapies, radiofrequency ablation (RFA) is currently regarded as the most promising one, since RFA achieves high eradication rates of dysplasia and intestinal metaplasia with minimal complications. Patients with BE are advised to undergo regular endoscopic surveillance for dysplasia or cancer and endoscopy with four quadrant biopsy sampling at intervals of 1-2 cm of the entire length of BE remains the current standard for the detection of dysplasia or cancer. The management of BE depends on the histology of the biopsy specimens obtained during endoscopy, which includes non-dysplastic BE (ND-BE), low grade dysplasia, high grade dysplasia and adenocarcinoma. However, histological evaluation of dysplasia is fraught with error because of inter-observer variability even among expert gastrointestinal pathologists, and as a result, it often leads to false-negative or false-positive diagnoses. Non-dysplastic mucosa in BE shows clonal molecular aberrations, loss of cell cycle control, and other features of "neoplasia". These changes occur prior to morphologic expression of neoplasia (dysplasia). Given the difficulties of dysplasia assessment in mucosal biopsies, the molecular characteristics of ND-BE and LGD, and safe and effective profiles of RFA, this technique should be considered as a treatment option for the whole spectrum of BE patients.