Endoscopic Therapy in Barrett's Esophagus.

Area of Science:

• Gastroenterology
• Endoscopy
• Oncology

Background:

• Dysplastic Barrett's esophagus (BE) and early esophageal adenocarcinoma (EAC) are managed with endoscopic eradication therapy (EET).
• Successful EET necessitates a structured, evidence-based approach for optimal patient outcomes.

Purpose of the Study:

• To outline the essential components of successful endoscopic eradication therapy (EET) for dysplastic Barrett's esophagus (BE) and early esophageal adenocarcinoma (EAC).
• To emphasize the importance of accurate diagnosis, appropriate technique selection, and multidisciplinary care in managing BE and EAC.

Main Methods:

• Recognition and resection of visible neoplasia using endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD).
• Ablation techniques, including radiofrequency ablation (RFA), hybrid APC, and cryoballoon ablation, for eradicating residual BE.
• Integration of patient selection, multidisciplinary team (MDT) involvement, acid control, and surveillance.

Main Results:

• EET is an effective and safe standard of care for dysplastic BE and early EAC.
• High-quality optical diagnosis, meticulous resection, and accurate histopathology are critical for successful outcomes.
• Ablation, particularly RFA, is recommended for durable remission.

Conclusions:

• EET is central to managing dysplastic BE and early EAC, requiring high-quality diagnostics and techniques.
• Specialist, multidisciplinary centers are best equipped to deliver tailored, context-specific care for these conditions.
• Radiofrequency ablation is the first-line option for durable remission in most cases.