The endoscopic management of Barrett's esophagus (BE) has changed with the emergence of novel endoscopic technologies and new data informing the care of dysplastic BE and early adenocarcinoma. These changes include an expanded use of endoscopic ablative therapy as well new recommendations for surveillance intervals. For most patients with BE and high-grade dysplasia (HGD), endoscopic ablative therapy is the preferred treatment strategy. Ablation has consistently been shown to be effective, with less morbidity compared with surgery. The best approach to treatment of adenocarcinoma with submucosal invasion is not clear as relevant data are conflicting. Traditionally, submucosal invasion was a contradiction to endoscopic therapy of esophageal adenocarcinoma, but recent data suggest that both endoscopic resection with ablation and esophagectomy may be acceptable treatment options in some settings. At present, surveillance for patients with baseline HGD or intramucosal carcinoma is suggested every 3 months in the first year following complete eradication of intestinal metaplasia, every 6 months in the second year, and annually thereafter.
Get full access to this article
View all access options for this article.
References
1.
ShaheenNJ, FalkGW, IyerPG, et al.ACG Clinical Guideline: Diagnosis and Management of Barrett's Esophagus. Am J Gastroenterol, 2016; 111:30–50.
2.
SharmaP, MoralesTG, SamplinerRE. Short segment Barrett's esophagus—the need for standardization of the definition and of endoscopic criteria. Am J Gastroenterol, 1998; 93:1033–1036.
3.
SharmaP, DentJ, ArmstrongD, et al.The development and validation of an endoscopic grading system for Barrett's esophagus: The Prague C & M criteria. Gastroenterology, 2006; 131:1392–1399.
4.
SikkemaM, de JongePJ, SteyerbergEW, et al.Risk of esophagealadenocarcinoma and mortality in patients with Barrett's esophagus: A systematic review and meta-analysis. Clin Gastroenterol Hepatol, 2010; 8:235–244.
5.
HurC, MillerM, KongCY, et al.Trends in esophageal adenocarcinoma incidence and mortality. Cancer, 2013; 119:1149–1158.
6.
JayasekeraC, TaylorAC, DesmondPV, et al.Added value of narrow band imaging and confocal laser endomicroscopy in detecting Barrett's esophagus neoplasia. Endoscopy, 2012; 44:1089–1095.
7.
PechO, BehrensA, MayA, et al.Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with highgrade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett' oesophagus. Gut, 2008; 57:1200–1206.
8.
MannerH, PechO, HeldmannY, et al.Efficacy, safety, and long-term results of endoscopic treatment for early stage adenocarcinoma of the esophagus with low-risk sm1 invasion. Clin Gastroenterol Hepatol, 2013; 11:630–635.
9.
MontgomeryE, BronnerMP, GoldblumJR, et al.Reproducibility of the diagnosis of dysplasia in Barrett esophagus: A reaffirmation. Hum Pathol, 2001; 32:368–378.
10.
CurversWL, ten KateFJ, KrishnadathKK, et al.Low-grade dysplasia in Barrett's esophagus: Overdiagnosed and underestimated. Am J Gastroenterol, 2010; 105:1523–1530.
11.
DuitsLC, PhoaKN, CurversWL, et al.Barrett's oesophagus patients with low-grade dysplasia can be accurately risk-stratified after histological review by an expert pathology panel. Gut, 2015; 64:700–706.
12.
OverholtBF, LightdaleCJ, WangKK, et al.Photodynamic therapy with porfimer sodium for ablation of high-grade dysplasia in Barrett's esophagus: International, partially blinded, randomized phase III trial. Gastrointest Endosc, 2005; 62:488–498.
13.
ShaheenNJ, SharmaP, OverholtBF, et al.Radiofrequency ablation in Barrett's esophagus with dysplasia. N Engl J Med, 2009; 360:2277–2288.
14.
ShaheenNJ, GreenwaldBD, PeeryAF, et al.Safety and efficacy of endoscopic spray cryotherapy for Barrett's esophagus with high-grade dysplasia. Gastrointest Endosc, 2010; 71:680–685.
15.
GosainS, MercerK, TwaddellWS, et al.Liquid nitrogen spray cryotherapy in Barrett's esophagus with high-grade dysplasia: Long-term results. Gastrointest Endosc, 2013; 78:260–265.
16.
PrasadGA, WangKK, ButtarNS, et al.Long-term survival following endoscopic and surgical treatment of high-grade dysplasia in Barrett's esophagus. Gastroenterology, 2007; 132:1226–1233.
17.
LeersJM, DeMeesterSR, OezcelikA, et al.The prevalence of lymph node metastases in patients with T1 esophageal adenocarcinoma a retrospective review of esophagectomy specimens. Ann Surg, 2011; 253:271–278.
18.
SepesiB, WatsonTJ, ZhouD, et al.Are endoscopic therapies appropriate for superficial submucosal esophageal adenocarcinoma? An analysis of esophagectomy specimens. J Am Coll Surg, 2010; 210:418–427.
19.
GuptaM, IyerPG, LutzkeL, et al.Recurrence of esophageal intestinal metaplasia after endoscopic mucosal resection and radiofrequency ablation of Barrett's esophagus: Results from a US Multicenter Consortium. Gastroenterology, 2013; 145:79–86.
20.
ShaheenNJ, OverholtBF, SamplinerRE, et al.Durability of radiofrequency ablation in Barrett's esophagus with dysplasia. Gastroenterology, 2011; 141:460–468.
21.
AndersM, BahrC, El-MasryMA, et al.Long-term recurrence of neoplasia and Barrett's epithelium after complete endoscopic resection. Gut, 2014; 63:1535–1543.
22.
PasrichaS, BulsiewiczWJ, HathornKE, et al.Durability and predictors of successful radiofrequency ablation for Barrett's esophagus. Clin Gastroenterol Hepatol, 2014; 12:1840–1847.
23.
TitiM, OverhiserA, UlusaracO, et al.Development of subsquamous high-grade dysplasia and adenocarcinoma after successful radiofrequency ablation of Barrett's esophagus. Gastroenterology, 2012; 143:564–566.
24.
OrmanES, KimHP, BulsiewiczWJ, et al.Intestinal metaplasia recurs infrequently in patients successfully treated for Barrett's esophagus with radiofrequency ablation. Am J Gastroenterol, 2013; 108:187–195.
25.
PhoaKN, van VilsterenFG, WeustenBL, et al.Radioquency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia: A randomized clinical trial. JAMA, 2014; 311:1209–1217.
26.
PhoaKN, PouwRE, van VilsterenFG, et al.Remission of Barrett's esophagus with early neoplasia 5 years after radiofrequency ablation with endoscopic resection: A Netherlands cohort study. Gastroenterology, 2013; 145:96–104.
27.
GaddamS, SinghM, BalasubramanianG, et al.Persistence of non-dysplastic Barrett's esophagus identifies patients at lower risk for esophageal adenocarcinoma: Results from a large multicenter cohort. Gastroenterology, 2013; 145:548–553.
28.
HaidryRJ, DunnJM, ButtMA, et al.Radiofrequency ablation and endoscopic mucosal resection for dysplastic Barrett's esophagus and early esophageal adenocarcinoma: Outcomes of the UK national halo RFA registry. Gastroenterology, 2013; 145:87–95.
29.
LeeJK, CameronRG, BinmoellerKF, et al.Recurrence of subsquamous dysplasia and carcinoma after successful endoscopic and radiofrequency ablation therapy for dysplastic Barrett's esophagus. Endoscopy, 2013; 45:571–574.
30.
GrayNA, OdzeRD, SpechlerSJ. Buried metaplasia after endoscopic ablation of Barrett's esophagus: A systematic review. Am J Gastroenterol, 2011; 106:1899–1908.
31.
ZhouC, TsaiTH, LeeHC, et al.Characterization of buried glands before and after radiofrequency ablation by using 3-dimensional optical coherence tomography (with videos). Gastrointest Endosc, 2012; 76:32–40.
32.
GuptaN, MathurSC, DumotJA, et al.Adequacy of esophageal squamous mucosa specimens obtained during endoscopy: Are standard biopsies sufficient for postablation surveillance in Barrett's esophagus?. Gastrointest Endosc, 2012; 75:11–18.
33.
ShaheenNJ, PeeryAF, OverholtBF, et al.Biopsy depth after radiofrequency ablation of dysplastic Barrett's esophagus. Gastrointest Endosc, 2010; 72:490–496.
