What is next? Management following endoscopic resection of barrett neoplasia - Controversies and shifting paradigms

Endoscopic resection (ER) is recommended for patients with a visible lesion in Barrett esophagus containing low-grade dysplasia, high-grade dysplasia, or T1 esophageal adenocarcinoma (EAC). ER is considered curative if the resection margins are free from neoplasia and no high-risk histological features, such as deep submucosal invasion, (lympho)vascular invasion, or poor tumour differentiation, are present. Subsequent ablation of the remaining Barrett segment is typically advised to prevent development of metachronous neoplasia. However, in a subset of patients, histopathology may reveal vertical tumour-positive resection margins or high-risk features of EAC. In such cases, management options traditionally involved esophagectomy and/or ((neo)adjuvant) chemo/radiotherapy due to the risk of local recurrence and lymph node metastasis, but strict endoscopic follow-up is increasingly being recognized as alternative approach. This review explores current evidence, controversies, and evolving strategies in the management following an ER for Barrett-related neoplasia.