Abstract
Background
Endoscopic eradication therapy for dysplastic Barrett’s esophagus (BE) comprises resection and mucosal ablation techniques. Over the years, these techniques have been tried with success, not only for dysplastic Barrett’s epithelium but also for non-dysplastic Barrett’s epithelium and early adenocarcinoma. Endoscopic resection is usually carried out for visible lesions, either as endoscopic mucosal resection (EMR), which is practiced widely in Western countries, or as endoscopic submucosal dissection, which is more popular in Japan and throughout Asia. Among ablative techniques are photodynamic therapy, cryotherapy, and radiofrequency ablation (RFA).
Methods
We reviewed the published evidence pertaining to endoscopic treatments of dysplastic BE, with emphasis on the various resection and ablative techniques, their safety, efficacy, durability of effect, and tolerability.
Results
Both resection and ablation procedures performed endoscopically have been proved effective, and safe for treating dysplastic BE and early adenocarcinoma. Among the ablative techniques, RFA has shown to be more effective and safe, and is preferred for most cases.
Conclusions
Endoscopic therapies have revolutionized the treatment of BE and have minimized the need for surgical intervention in many patients. Concomitant treatment of acid reflux with proton pump inhibitors and continuous surveillance are essential. Combination techniques such as EMR followed by RFA may be also considered in some cases.
Similar content being viewed by others
References
Akiyama J, Triadafilopoulos G (2010) Endoscopic ablation therapy of Barrett’s esophagus. Minerva Gastroenterol Dietol 56:405–420
Arora G, Basra S, Roorda AK et al (2009) Radiofrequency ablation of Barrett’s esophagus. Eur Surg 41:19–25
ASGE Standards of Practice Committee (2012) The role of endoscopy in Barrett’s esophagus and other premalignant conditions of the esophagus. Gastrointest Endosc 76:1087–1094
Mino-Kenudson M, Hull MJ, Brown I et al (2007) EMR for Barrett’s esophagus-related superficial neoplasms offers better diagnostic reproducibility than mucosal biopsy. Gastrointest Endosc 66(4):660–666 quiz 767, 769
Sharma P, Dent J, Armstrong D et al (2006) The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology 131:1392–1399
Fleischer DE, Odze R, Overholt BF et al (2010) The case for endoscopic reatment of non-dysplastic and low-grade dysplastic Barrett’s esophagus. Dig Dis Sci 55:1918–1931
Pouw RE, van Vilsteren FG, Peters FP et al (2011) Randomized trial on endoscopic resection-cap versus multiband mucosectomy for piecemeal endoscopic resection of early Barrett’s neoplasia. Gastrointest Endosc 74:35–43
Pouw RE, Bergman JJ (2013) Radiofrequency ablation for Barrett’s esophagus, for whom and by whom? Clin Gastroenterol Hepatol 11:1256–1258
Qumseya BJ, David W, Wolfsen HC (2013) Photodynamic therapy for Barrett’s esophagus and esophageal carcinoma. Clin Endosc 46:30–37
Ackroyd R, Brown NJ, Davis MF et al (2000) Photodynamic therapy for dysplastic Barrett’s oesophagus: a prospective, double blind, randomised, placebo controlled trial. Gut 47:612–617
Overholt BF, Lightdale CJ, Wang KW et al (2005) Photodynamic therapy with porfimer sodium for ablation of high-grade dysplasia in Barrett’s esophagus: international, partially blinded, randomized phase III trial. Gastrointest Endosc 62:488–498
Gray J, Fullarton GM (2013) Long term efficacy of photodynamic therapy (PDT) as an ablative therapy of high grade dysplasia in Barrett’s oesophagus. Photodiagn Photodyn Ther 10:561–565
Ertan A, Zaheer I, Correa AM et al (2013) Photodynamic therapy vs radiofrequency ablation for Barrett’s dysplasia: efficacy, safety and cost-comparison. World J Gastroenterol 19:7106–7113
Wang KK, Kim JY (2003) Photodynamic therapy in Barrett’s esophagus. Gastrointest Endosc Clin North Am 13:483–489
Dunn JM, Mackenzie GD, Banks MR et al (2013) A randomised controlled trial of ALA vs photofrin photodynamic therapy for high-grade dysplasia arising in Barrett’s oesophagus. Lasers Med Sci 28:707–715
Ban S, Mino M, Nishioka NS et al (2004) Histopathologic aspects of photodynamic therapy for dysplasia and early adenocarcinoma arising in Barrett’s esophagus. Am J Surg Pathol 28:1466–1473
Sharma VK, Wang KK, Overholt BF et al (2007) Balloon-based, circumferential, endoscopic radiofrequency ablation of Barrett’s esophagus: 1-year follow-up of 100 patients. Gastrointest Endosc 65:185–195
Fleischer DE, Overholt BF, Sharma VK et al (2008) Endoscopic ablation of Barrett’s esophagus: a multicenter study with 2.5-year follow-up. Gastrointest Endosc 68:867–876
Fleischer DE, Overholt BF, Sharma VK et al (2010) Endoscopic radiofrequency ablation for Barrett’s esophagus: 5-year outcomes from a prospective multicenter trial. Endoscopy 42:781–789
Shaheen NJ, Sharma P, Overholt BF et al (2009) Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med 360:2277–2288
Shaheen NJ, Overholt BF, Sampliner RE et al (2011) Durability of radiofrequency ablation in Barrett’s esophagus with dysplasia. Gastroenterology 141:460–468
Phoa KY, van Vilsteren FG, Pouw RE et al (2013) Radiofrequency ablation in Barrett’s esophagus with confirmed low-grade dysplasia: interim results of a European multicenter randomized controlled trial (SURF). Gastroenterology 144(Suppl 1):S–187
Chadwick G, Groene O, Markar SR et al (2014) Systematic review comparing radiofrequency ablation and complete endoscopic resection in treating dysplastic Barrett’s esophagus: a critical assessment of histologic outcomes and adverse events. Gastrointest Endosc 79:718–731
Bulsiewicz WJ, Kim HP, Dellon ES et al (2013) Safety and efficacy of endoscopic mucosal therapy with radiofrequency ablation for patients with neoplastic Barrett’s esophagus. Clin Gastroenterol Hepatol 11:636–642
Gupta M, Iyer PG, Lutzke L et al (2013) Recurrence of esophageal intestinal metaplasia after endoscopic mucosal resection and radiofrequency ablation of Barrett’s esophagus: results from a US multicenter consortium. Gastroenterology 145:79–86
Korst RJ, Santana-Joseph S, Rutledge JR et al (2013) Patterns of recurrent and persistent intestinal metaplasia after successful radiofrequency ablation of Barrett’s esophagus. J Thorac Cardiovasc Surg 145:1529–1534
Orman ES, Kim HP, Bulsiewicz WJ et al (2013) Intestinal metaplasia recurs infrequently in patients successfully treated for Barrett’s esophagus with radiofrequency ablation. Am J Gastroenterol 108:187–195 quiz 196
Korst RJ, Santana-Joseph S, Rutledge JR et al (2011) Effect of hiatal hernia size and columnar segment length on the success of radiofrequency ablation for Barrett’s esophagus: a single center, phase II clinical trial. J Thorac Cardiovasc Surg 142:1168–1173
van Vilsteren FG, Alvarez Herrero L, Pouw RE et al (2013) Predictive factors for initial treatment response after circumferential radiofrequency ablation for Barrett’s esophagus with early neoplasia: a prospective multicenter study. Endoscopy 45:516–525
Greenwald BD, Dumot JA (2011) Cryotherapy for Barrett’s esophagus and esophageal cancer. Current Opin Gastroenterol 27:363–367
Shaheen L, Bruce J, Greenwald D et al (2010) Safety and efficacy of endoscopic spray cryotherapy for Barrett’s esophagus with high-grade dysplasia. Gastrointest Endosc 71:680–685
Gosain S, Mercer K, Twaddell WS et al (2013) Liquid nitrogen spray cryotherapy in Barrett’s esophagus with high-grade dysplasia: long-term results. Gastrointest Endosc 78:260–265
Halsey KD, Chang JW, Waldt A et al (2011) Recurrent disease following endoscopic ablation of Barrett’s high-grade dysplasia with spray cryotherapy. Endoscopy 43:844–848
Inoue H, Fukami N, Yoshida T et al (2002) Endoscopic mucosal resection for esophageal and gastric cancers. J Gastroenterol Hepatol 17:382–388
May A, Gossner L, Behrens A et al (2003) A prospective randomized trial of two different endoscopic resection techniques for early stage cancer of the esophagus. Gastrointest Endosc 58:167–175
Alvarez Herrero L, Pouw RE, van Vilsteren FGI et al (2011) Safety and efficacy of multiband mucosectomy in 1060 resections in Barrett’s esophagus. Endoscopy 43:177–183
Pouw RE, van Vilsteren FGI, Peters FP et al (2011) Randomized trial on endoscopic resection—cap versus multiband mucosectomy for piecemeal endoscopic resection of early Barrett’s neoplasia. Gastrointest Endosc 74:35–43
Koike T, Nakagawa K, Iijima K et al (2013) Endoscopic resection (endoscopic submucosal dissection/endoscopic mucosal resection) for superficial Barrett’s esophageal cancer. Dig Endosc 25(Suppl 1):20–28
Cao Y, Liao C, Tan A et al (2009) Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal resection for tumors of the gastrointestinal tract. Endoscopy 41:751–757
Barret M, Pratico CA, Beuvon F et al (2013) Esophageal circumferential en bloc endoscopic submucosal dissection: assessment of a new technique. Surg Laparosc Endosc Percutan Tech 23:e182–e187
Wen J, Yang Y, Liu Q et al (2014) Preventing stricture formation by covered esophageal stent placement after endoscopic submucosal dissection for early esophageal cancer. Dig Dis Sci 59:658–663
Seewald S, Ang TL, Gotoda T et al (2008) Total endoscopic resection of Barrett esophagus. Endoscopy 40:1016–1020
Pouw RE, Seewald S, Gondrie JJ et al (2010) Stepwise radical endoscopic resection for eradication of Barrett’s oesophagus with early neoplasia in a cohort of 169 patients. Gut 59:1169–1177
Chung A, Bourke MJ, Hourigan LF et al (2011) Complete Barrett’s excision by stepwise endoscopic resection in short-segment disease: long term outcomes and predictors of stricture. Endoscopy 43:1025–1032
Ezoe Y, Muto M, Horimatsu T et al (2011) Efficacy of preventive endoscopic balloon dilation for esophageal stricture after endoscopic resection. J Clin Gastroenterol 45:222–227
Manner H, Pech O, Heldmann Y et al (2014) Efficacy, safety, and long-term results of endoscopic treatment for early stage adenocarcinoma of the esophagus with low-risk Sm1 invasion. Clin Gastroenterol Hepatol 11:630–635 quiz e45
Chennat J, Konda VJA, Ross AS et al (2009) Complete Barrett’s eradication endoscopic mucosal resection: an effective treatment modality for high-grade dysplasia and intramucosal carcinoma—an American single-center experience. Am J Gastroenterol 104:2684–2692
Pech O, May A, Manner H et al (2013) Long-term efficacy and safety of endoscopic resection for patients with mucosal adenocarcinoma of the esophagus. Gastroenterology 146:652–660
Anders M, Bähr C, Abbas El-Masry M et al (2013) Long-term recurrence of neoplasia and Barrett’s epithelium after complete endoscopic resection. Gut. doi:10.1136/gutjnl-2013-305538
Pech O, Behrens A, May A et al (2008) Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett’s oesophagus. Gut 57:1200–1206
Pacifico RJ, Wang KK, Wongkeesong L-M et al (2003) Combined endoscopic mucosal resection and photodynamic therapy versus esophagectomy for management of early adenocarcinoma in Barrett’s esophagus. Clin Gastroenterol Hepatol 1:252–257
Pouw RE, Wirths K, Eisendrath P et al (2010) Efficacy of radiofrequency ablation combined with endoscopic resection for Barrett’s esophagus with early neoplasia. Clin Gastroenterol Hepatol 8:23–29
Haidry RJ, Dunn JM, Butt MA et al (2013) Radiofrequency ablation and endoscopic mucosal resection for dysplastic Barrett’s esophagus and early esophageal adenocarcinoma: outcomes of the UK National Halo RFA Registry. Gastroenterology 145:87–95
Kim HP, Bulsiewicz WJ, Cotton CC et al (2012) Focal endoscopic mucosal resection before radiofrequency ablation is equally effective and safe compared with radiofrequency ablation alone for the eradication of Barrett’s esophagus with advanced neoplasia. Gastrointest Endosc 76:733–739
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Subramanian, C.R., Triadafilopoulos, G. Endoscopic Treatments for Dysplastic Barrett’s Esophagus: Resection, Ablation, What Else?. World J Surg 39, 597–605 (2015). https://doi.org/10.1007/s00268-014-2636-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-014-2636-6