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Emerging Concepts for the Endoscopic Management of Superficial Esophageal Adenocarcinoma

  • Review Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Endoscopic therapy has revolutionized the treatment of Barrett’s esophagus with high-grade dysplasia (HGD) or intramucosal adenocarcinoma by allowing preservation of the esophagus in many patients who would previously have had an esophagectomy. This paradigm shift initially occurred at high-volume centers in North America and Europe but now is becoming mainstream therapy. There is a lack of uniform guidelines and algorithms for the management of these patients. Our aim was to review important concepts and pitfalls in the endoscopic management of superficial esophageal adenocarcinoma.

Methods

A small group colloquium consisting of gastroenterologists, surgeons, and pathologists reviewed published data and discussed personal and institutional experiences with endotherapy for HGD and superficial esophageal adenocarcinoma.

Results

The group reviewed data and provided recommendations and management algorithms for seven areas pertaining to endoscopic therapy for Barrett’s HGD and superficial adenocarcinoma: (1) patient selection and evaluation; (2) imaging and biopsy techniques; (3) devices; (4) indications for resection versus ablation; (5) ER specimen handling, processing, and pathologic evaluation; (6) patient care and follow-up after endoscopic therapy; and (7) complications of endoscopic therapy and treatment options.

Conclusions

Endoscopic therapy is preferred over esophagectomy for most patients with HGD or intramucosal adenocarcinoma, and may be applicable to select patients with submucosal tumors. Clear guidelines and management algorithms will aid physicians and centers embarking on endoscopic therapy and enable a standardized approach to the management of these patients that is applicable internationally.

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Acknowledgments

The meeting that made this manuscript possible was funded by a grant from the Borchard Foundation. In particular, we thank the director, Dr. Kristen Beling, for her support and hospitality throughout the process. Additional support was provided by a much appreciated educational grant from Olympus Endoscopy. Lastly, this would not have been possible without generous donations by individuals committed to advancing the care of patients with esophageal disease including Ms. Jo Skibby, Mr. and Mrs. Michael Greenberg, Mr. and Mrs. Darrell Anderson, Ms. Judy Engell, and Mr. Donald Hunn.

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Authors and Affiliations

  1. Department of Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA, 90033, USA

    Christina L. Greene, Stephanie G. Worrell, Tom R. DeMeester & Steven R. DeMeester

  2. Department of Surgery, North Tyneside General Hospital, Durham University, Tyne and Wear, UK

    Stephen E. Attwood

  3. Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA

    Parakrama Chandrasoma & John Vallone

  4. Division of Gastroenterology and Hepatology, University of California, Irvine, Orange, CA, USA

    Kenneth Chang

  5. Department of Surgery, Notre Dame University School of Medicine, Sydney, Sydney, Australia

    Reginald V. Lord

  6. Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA

    Elizabeth Montgomery

  7. Gastroenterology and Interventional Endoscopy, St. John of God Hospital, Teaching Hospital of the University of Regensburg, Regensburg, Germany

    Oliver Pech

  8. Institute of Pathology, Klinikum Bayreuth, Preuschwitzerstr, Bayreuth, Germany

    Michael Vieth

  9. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Kenneth K. Wang

Authors
  1. Christina L. Greene
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  2. Stephanie G. Worrell
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  4. Parakrama Chandrasoma
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  6. Tom R. DeMeester
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  8. Elizabeth Montgomery
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  9. Oliver Pech
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  10. John Vallone
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  11. Michael Vieth
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  12. Kenneth K. Wang
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  13. Steven R. DeMeester
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Corresponding author

Correspondence to Steven R. DeMeester.

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Greene, C.L., Worrell, S.G., Attwood, S.E. et al. Emerging Concepts for the Endoscopic Management of Superficial Esophageal Adenocarcinoma. J Gastrointest Surg 20, 851–860 (2016). https://doi.org/10.1007/s11605-015-3056-0

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  • DOI: https://doi.org/10.1007/s11605-015-3056-0

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