Ablation of Barrett's mucosa

Barrett's esophagus is the premalignant lesion of adenocarcinoma of the esophagus and gastric cardia, two rapidly increasing incidence cancers. Barrett's esophagus has been documented to be reversed with a combination of pharmacologic acid control or antireflux surgery and endoscopic ablative therapy. A variety of endoscopic techniques can be applied to ablate the Barrett's epithelium. With sufficient acid reduction, squamous repopulation of the injured area occurs. This injury can be accomplished using laser, photodynamic therapy, electrocautery, and mechanical techniques. The relative success rates, complications, and consistency of depth of injury have not been well defined. Ablative therapy represents an exciting alternative to surgery in elderly patients with comorbidity or in patients averse to surgical therapy. Because of the local nature of this therapy, improved clinical staging is essential to appropriately select candidates. Endoscopic ablation therapy of Barrett's esophagus remains experimental until reversal has been documented over a longer period of time and criteria are validated to select appropriate candidates at high risk of developing adenocarcinoma of the esophagus.