Ablative therapies for the columnar-lined esophagus

Endoscopic ablative therapy could reduce the risk for the development of adenocarcinoma in patients with Barrett's esophagus. Combination therapy, which includes pharmacologic or surgical acid control plus endoscopic mucosal ablation, can reverse Barrett's esophagus that has not been accomplished with prior medical or surgical therapy. Pharmacologic esophageal acid control often takes higher than usual doses of proton pump inhibitor therapy. The preliminary results of endoscopic ablation techniques, including laser, photodynamic therapy, and multipolar electrocoagulation, are reviewed. The goal of ablative therapy is to eliminate all intestinal metaplasia and therefore the risk for the development of adenocarcincoma. Endoscopic ablative therapies need to be validated with larger and longer term trials. Better criteria to estimate the risk for the development of adenocarcinoma are needed to select appropriate candidates for combination therapy.