Comparison of Invasive Interventions for Halting the Progression of Barrett's Esophagus

Barrett's esophagus (BE) is a premalignant condition that predisposes to esophageal adenocarcinoma, particularly in the presence of dysplasia. Once dysplastic change is identified, invasive interventions are often considered in efforts to prevent malignant progression. This review synthesizes evidence from an extended period of time to truly provide a comprehensive review regarding the efficacy, safety, and clinical utility of invasive therapies, including radiofrequency ablation (RFA), cryotherapy, argon plasma coagulation (APC), endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), photodynamic therapy, and esophagectomy. RFA remains the gold standard ablative therapy, achieving complete eradication of dysplasia and intestinal metaplasia with durable outcomes and a favorable safety profile. Cryotherapy provides comparable results and is especially valuable in patients with contraindications to thermal ablation or RFA-refractory disease. Of note, further head-to-head, larger clinical trials would be required to truly underline the more efficacious intervention. EMR and ESD allow removal of visible or nodular lesions and provide critical histopathologic staging, with ESD offering superior en bloc and curative resection rates but at greater procedural risk. APC achieves high eradication rates but with an elevated frequency of adverse events, limiting broad adoption. Current guidelines recommend endoscopic eradication therapy for high-grade dysplasia and emphasize individualized management for low-grade disease, underscoring the central role of RFA combined with resection when indicated. Remaining challenges include variability in operator expertise, uncertainty regarding long-term recurrence rates for newer therapies, and the need for standardized surveillance and biomarker-driven risk stratification. Collectively, the data support a patient-specific, stepwise strategy to halt disease progression while minimizing treatment-related morbidity.