Endoscopic Therapy in Barrett's Esophagus

Endoscopic eradication therapy (EET) is the standard of care for dysplastic Barrett's esophagus (BE) and early esophageal adenocarcinoma (EAC). Successful outcomes require a structured, evidence-based approach.

Recognising and removing visible neoplasia is a crucial step in EET. Endoscopic mucosal resection (EMR) is efficient and safe for most dysplastic lesions, while endoscopic submucosal dissection (ESD) enables en bloc resection and more precise staging when submucosal invasion is suspected. Radiofrequency ablation remains the most established method for eradicating residual BE, with hybrid APC and cryoballoon ablation emerging as potential alternatives. Optimal therapy also depends on appropriate patient selection, multidisciplinary team involvement (MDT), effective acid control, and structured surveillance.

(1) EET is effective, safe, and now central to managing dysplastic BE and early EAC. (2) High-quality optical diagnosis, careful technique selection, meticulous resection, and accurate histopathology assessment underpin good outcomes. (3) In most cases, ablation is recommended for durable remission, with RFA the first-line option. (4) Care is best delivered by specialist, multidisciplinary centres that adapt therapy to the individual patient within their wider clinical context.