Challenges in Endoscopic Eradication Therapy: Refractory and Recurrent Barrett's Esophagus

Advances in endoscopic eradication therapy (EET) have improved the ability to achieve complete eradication of intestinal metaplasia. A multimodal approach of endoscopic resection followed by ablative therapy remains the cornerstone of EET for BE and BE-related dysplasia. However, challenges exist in patients with refractory and recurrent BE. Modifiable risk factors such as uncontrolled reflux should be addressed medically or surgically. Salvage therapy can be utilized in refractory BE, but endoscopists should be cautious of adverse effects such as stricture formation. Principles of management of recurrent BE are similar to patients undergoing initial EET.