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Challenges in Endoscopic Eradication Therapy: Refractory and Recurrent Barrett's Esophagus
Kevin P Shah1, Vismaya Bachu2, Shirin Dey3
1Department of Gastroenterology and Hepatology, Northwestern Memorial Hospital, Chicago, IL, USA.
Gastrointestinal Endoscopy Clinics of North America
|November 19, 2025
Summary
Endoscopic eradication therapy (EET) effectively treats intestinal metaplasia but faces challenges with refractory and recurrent Barrett's esophagus (BE). Addressing risk factors and careful salvage therapy are key for successful BE management.
Area of Science:
- Gastroenterology
- Endoscopy
- Oncology
Background:
- Intestinal metaplasia management has advanced with endoscopic eradication therapy (EET).
- Barrett's esophagus (BE) and associated dysplasia require effective treatment strategies.
- Refractory and recurrent BE present ongoing clinical challenges.
Purpose of the Study:
- To review the current state of endoscopic eradication therapy (EET) for Barrett's esophagus (BE).
- To highlight challenges and management principles for refractory and recurrent BE.
- To emphasize the importance of addressing modifiable risk factors and potential adverse effects.
Main Methods:
- Review of current endoscopic eradication therapy (EET) techniques.
- Discussion of multimodal approaches including endoscopic resection and ablative therapy.
- Analysis of management strategies for refractory and recurrent Barrett's esophagus (BE).
Main Results:
- Endoscopic eradication therapy (EET) has improved complete eradication of intestinal metaplasia.
- A multimodal approach is the standard for BE and BE-related dysplasia.
- Refractory and recurrent BE cases require careful consideration of risk factors and salvage therapy.
Conclusions:
- Successful management of Barrett's esophagus (BE) relies on multimodal endoscopic eradication therapy (EET).
- Addressing modifiable risk factors like reflux is crucial for treatment success.
- Caution is advised regarding adverse effects, such as stricture formation, during salvage therapy for refractory BE.
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