ENDOSCOPIC TREATMENT OF ESOPHAGEAL NEOPLASIA: A DECADE OF EVOLUTION

Traditional therapy for early esophageal neoplasia has been esophagectomy. In the past decade, the approach to these conditions has rapidly evolved, such that endoscopic therapy has become the primary modality to treat patients with esophageal dysplasia and superficial carcinoma. A variety of modalities are available, including thermal methods, such as radiofrequency ablation and argon plasma coagulation; cryotherapy, including spray liquid nitrogen cryotherapy and balloon-based nitrous oxide cryotherapy; and tissue resection methods, such as endoscopic mucosal resection and endoscopic submucosal dissection. Level 1 evidence substantiates that patients treated with these therapies have a low risk of developing invasive cancer. These treatments demonstrate an excellent safety profile. Future work in this area will define the best modalities of treatment, assess the utility of endoscopic therapy in combination with radiation therapy and chemotherapy, and improve current screening regimens to allow earlier detection of neoplasia.