Endoscopic Treatment for Early Barrett's Neoplasia: A Western Perspective

Barrett's oesophagus (BE) is the sole established precursor to oesophageal adenocarcinoma, with striking contrasts in its epidemiology and management between the East and the West.

This review, based on a structured literature search, examines the key divergences in endoscopic management: highlighting the Western emphasis on eradication therapy using ablation techniques such as radiofrequency ablation, contrasted with the Eastern expertise in advanced resection techniques including endoscopic submucosal dissection.

Despite improving patient outcomes, significant challenges remain, including variable surveillance protocols, controversies regarding non-dysplastic BE and low-grade dysplasia, and optimal strategies for recurrent disease. As gastroesophageal reflux disease and long-segment BE rise in prevalence in the East, and Western proficiency in endoscopic submucosal dissection grows, these once-distinct approaches are poised to converge. As these treatment paradigms align, patients and clinicians alike stand to benefit from more effective, tailored care and better long-term outcomes.