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Endoscopic Treatments for Barrett’s Esophagus

  • Uma M. Sachdeva
  • Hans Gerdes
  • Daniela MolenaEmail author
Chapter

Abstract

Endoscopic interventions for Barrett’s esophagus are highly effective techniques for eradication of Barrett’s-associated dysplastic regions and superficial adenocarcinoma confined to the esophageal mucosa. Treatments include both ablative therapies and excisional techniques, which are applied in an independent or sequential fashion.

The development of endoscopic treatments for Barrett’s-associated dysplasia and early-stage neoplasms has allowed for effective treatment of these conditions through minimally invasive techniques and decreased the necessity for esophagectomy and its associated morbidity and mortality for early cancerous and precancerous lesions of the esophagus and esophagogastric junction.

Keywords

Barrett’s esophagus Barrett’s metaplasia Barrett’s low-grade dysplasia Barrett’s high-grade dysplasia Esophageal adenocarcinoma Radiofrequency ablation Cryoablation Endoscopic mucosa resection Endoscopic submucosal dissection 

Notes

Conflict of Interest

The authors have no conflict of interest to declare.

References

  1. 1.
    Committee ASoP, Evans JA, Early DS, et al. The role of endoscopy in Barrett’s esophagus and other premalignant conditions of the esophagus. Gastrointest Endosc. 2012;76:1087–94.CrossRefGoogle Scholar
  2. 2.
    Duits LC, Phoa KN, Curvers WL, 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;64:700–6.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Brimhall B, Wani S. Current endoscopic approaches for the treatment of Barrett esophagus. J Clin Gastroenterol. 2017;51:2–11.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Rastogi A, Puli S, El-Serag HB, Bansal A, Wani S, Sharma P. Incidence of esophageal adenocarcinoma in patients with Barrett’s esophagus and high-grade dysplasia: a meta-analysis. Gastrointest Endosc. 2008;67:394–8.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Kim SL, Waring JP, Spechler SJ, et al. Diagnostic inconsistencies in Barrett’s esophagus. Department of Veterans Affairs Gastroesophageal Reflux Study Group. Gastroenterology. 1994;107:945–9.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Woolf GM, Riddell RH, Irvine EJ, Hunt RH. A study to examine agreement between endoscopy and histology for the diagnosis of columnar lined (Barrett’s) esophagus. Gastrointest Endosc. 1989;35:541–4.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Eloubeidi MA, Provenzale D. Does this patient have Barrett’s esophagus? The utility of predicting Barrett’s esophagus at the index endoscopy. Am J Gastroenterol. 1999;94:937–43.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Gupta N, Gaddam S, Wani SB, Bansal A, Rastogi A, Sharma P. Longer inspection time is associated with increased detection of high-grade dysplasia and esophageal adenocarcinoma in Barrett’s esophagus. Gastrointest Endosc. 2012;76:531–8.CrossRefGoogle Scholar
  9. 9.
    Cassani L, Sumner E, Slaughter JC, Yachimski P. Directional distribution of neoplasia in Barrett’s esophagus is not influenced by distance from the gastroesophageal junction. Gastrointest Endosc. 2013;77:877–82.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Yachimski P, Hur C. Evidence-based endoscopic management of Barrett’s esophagus. Gastroenterol Rep (Oxf). 2015;3:54–62.CrossRefGoogle Scholar
  11. 11.
    Sharma P, Hawes RH, Bansal A, et al. Standard endoscopy with random biopsies versus narrow band imaging targeted biopsies in Barrett’s oesophagus: a prospective, international, randomised controlled trial. Gut. 2013;62:15–21.PubMedCrossRefGoogle Scholar
  12. 12.
    Wolfsen HC, Crook JE, Krishna M, et al. Prospective, controlled tandem endoscopy study of narrow band imaging for dysplasia detection in Barrett’s Esophagus. Gastroenterology. 2008;135:24–31.PubMedCrossRefGoogle Scholar
  13. 13.
    Mannath J, Subramanian V, Hawkey CJ, Ragunath K. Narrow band imaging for characterization of high grade dysplasia and specialized intestinal metaplasia in Barrett’s esophagus: a meta-analysis. Endoscopy. 2010;42:351–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Sharma P, Falk GW, Weston AP, Reker D, Johnston M, Sampliner RE. Dysplasia and cancer in a large multicenter cohort of patients with Barrett’s esophagus. Clin Gastroenterol Hepatol. 2006;4:566–72.PubMedCrossRefGoogle Scholar
  15. 15.
    Wong T, Tian J, Nagar AB. Barrett’s surveillance identifies patients with early esophageal adenocarcinoma. Am J Med. 2010;123:462–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Fountoulakis A, Zafirellis KD, Dolan K, Dexter SP, Martin IG, Sue-Ling HM. Effect of surveillance of Barrett’s oesophagus on the clinical outcome of oesophageal cancer. Br J Surg. 2004;91:997–1003.PubMedCrossRefGoogle Scholar
  17. 17.
    Corley DA, Levin TR, Habel LA, Weiss NS, Buffler PA. Surveillance and survival in Barrett’s adenocarcinomas: a population-based study. Gastroenterology. 2002;122:633–40.PubMedCrossRefGoogle Scholar
  18. 18.
    Overholt BF, Wang KK, Burdick JS, et al. Five-year efficacy and safety of photodynamic therapy with Photofrin in Barrett’s high-grade dysplasia. Gastrointest Endosc. 2007;66:460–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Prasad GA, Wang KK, Buttar NS, et al. Long-term survival following endoscopic and surgical treatment of high-grade dysplasia in Barrett’s esophagus. Gastroenterology. 2007;132:1226–33.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Basu KK, Pick B, Bale R, West KP, de Caestecker JS. Efficacy and one year follow up of argon plasma coagulation therapy for ablation of Barrett’s oesophagus: factors determining persistence and recurrence of Barrett’s epithelium. Gut. 2002;51:776–80.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Milashka M, Calomme A, Van Laethem JL, et al. Sixteen-year follow-up of Barrett’s esophagus, endoscopically treated with argon plasma coagulation. United European Gastroenterol J. 2014;2:367–73.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Shaheen NJ, Overholt BF, Sampliner RE, et al. Durability of radiofrequency ablation in Barrett’s esophagus with dysplasia. Gastroenterology. 2011;141:460–8.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Munoz-Largacha JA, Litle VR. Endoscopic mucosal ablation and resection of Barrett’s esophagus and related diseases. J Visc Surg. 2017;3:128.CrossRefGoogle Scholar
  24. 24.
    Overwater A, Weusten B. Cryoablation in the management of Barrett’s esophagus. Curr Opin Gastroenterol. 2017;33:261–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Ghorbani S, Tsai FC, Greenwald BD, et al. Safety and efficacy of endoscopic spray cryotherapy for Barrett’s dysplasia: results of the National Cryospray Registry. Dis Esophagus. 2016;29:241–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Sengupta N, Ketwaroo GA, Bak DM, et al. Salvage cryotherapy after failed radiofrequency ablation for Barrett’s esophagus-related dysplasia is safe and effective. Gastrointest Endosc. 2015;82:443–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Verbeek RE, Vleggaar FP, Ten Kate FJ, van Baal JW, Siersema PD. Cryospray ablation using pressurized CO2 for ablation of Barrett’s esophagus with early neoplasia: early termination of a prospective series. Endosc Int Open. 2015;3:E107–12.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Canto MI, Shin EJ, Khashab MA, et al. Safety and efficacy of carbon dioxide cryotherapy for treatment of neoplastic Barrett’s esophagus. Endoscopy. 2015;47:591.PubMedCrossRefGoogle Scholar
  29. 29.
    Scholvinck DW, Kunzli HT, Kestens C, et al. Treatment of Barrett’s esophagus with a novel focal cryoablation device: a safety and feasibility study. Endoscopy. 2015;47:1106–12.PubMedCrossRefGoogle Scholar
  30. 30.
    Kunzli HT, Scholvinck DW, Meijer SL, Seldenrijk KA, Bergman J, Weusten B. Efficacy of the CryoBalloon Focal Ablation System for the eradication of dysplastic Barrett’s esophagus islands. Endoscopy. 2017;49:169–75.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Greenwald BD, Dumot JA, Horwhat JD, Lightdale CJ, Abrams JA. Safety, tolerability, and efficacy of endoscopic low-pressure liquid nitrogen spray cryotherapy in the esophagus. Dis Esophagus. 2010;23:13–9.PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Ramay FH, Cui Q, Greenwald BD. Outcomes after liquid nitrogen spray cryotherapy in Barrett’s esophagus-associated high-grade dysplasia and intramucosal adenocarcinoma: 5-year follow-up. Gastrointest Endosc. 2017;86:626–32.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Gray NA, Odze RD, Spechler SJ. Buried metaplasia after endoscopic ablation of Barrett’s esophagus: a systematic review. Am J Gastroenterol. 2011;106:1899–908; quiz 909.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Halsey KD, Chang JW, Waldt A, Greenwald BD. Recurrent disease following endoscopic ablation of Barrett’s high-grade dysplasia with spray cryotherapy. Endoscopy. 2011;43:844–8.PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Xue HB, Tan HH, Liu WZ, et al. A pilot study of endoscopic spray cryotherapy by pressurized carbon dioxide gas for Barrett’s esophagus. Endoscopy. 2011;43:379–85.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Shaheen NJ, Greenwald BD, Peery AF, et al. Safety and efficacy of endoscopic spray cryotherapy for Barrett’s esophagus with high-grade dysplasia. Gastrointest Endosc. 2010;71:680–5.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    May A, Gossner L, Pech O, et al. Local endoscopic therapy for intraepithelial high-grade neoplasia and early adenocarcinoma in Barrett’s oesophagus: acute-phase and intermediate results of a new treatment approach. Eur J Gastroenterol Hepatol. 2002;14:1085–91.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Ciocirlan M, Lapalus MG, Hervieu V, et al. Endoscopic mucosal resection for squamous premalignant and early malignant lesions of the esophagus. Endoscopy. 2007;39:24–9.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Standards of Practice Committee, Wani S, Qumseya B, et al. Endoscopic eradication therapy for patients with Barrett’s esophagus-associated dysplasia and intramucosal cancer. Gastrointest Endosc. 2018;87:907–31.e9.CrossRefGoogle Scholar
  40. 40.
    Barret M, Belghazi K, Weusten BL, Bergman JJ, Pouw RE. Single-session endoscopic resection and focal radiofrequency ablation for short-segment Barrett’s esophagus with early neoplasia. Gastrointest Endosc. 2016;84:29–36.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Ell C, May A, Pech O, et al. Curative endoscopic resection of early esophageal adenocarcinomas (Barrett’s cancer). Gastrointest Endosc. 2007;65:3–10.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Shami VM, Villaverde A, Stearns L, et al. Clinical impact of conventional endosonography and endoscopic ultrasound-guided fine-needle aspiration in the assessment of patients with Barrett’s esophagus and high-grade dysplasia or intramucosal carcinoma who have been referred for endoscopic ablation therapy. Endoscopy. 2006;38:157–61.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Pouw RE, van Vilsteren FG, Peters FP, et al. Randomized trial on endoscopic resection-cap versus multiband mucosectomy for piecemeal endoscopic resection of early Barrett’s neoplasia. Gastrointest Endosc. 2011;74:35–43.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Pech O, Behrens A, May A, et al. 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. 2008;57:1200–6.PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    Esaki M, Matsumoto T, Hirakawa K, et al. Risk factors for local recurrence of superficial esophageal cancer after treatment by endoscopic mucosal resection. Endoscopy. 2007;39:41–5.PubMedCrossRefPubMedCentralGoogle Scholar
  46. 46.
    Chennat J, Konda VJ, Ross AS, et al. 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. 2009;104:2684–92.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Ishihara R, Iishi H, Takeuchi Y, et al. Local recurrence of large squamous-cell carcinoma of the esophagus after endoscopic resection. Gastrointest Endosc. 2008;67:799–804.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Ishihara R, Yamamoto S, Hanaoka N, et al. Endoscopic submucosal dissection for superficial Barrett’s esophageal cancer in the Japanese state and perspective. Ann Transl Med. 2014;2:24.PubMedPubMedCentralGoogle Scholar
  49. 49.
    Ishihara R, Iishi H, Uedo N, et al. Comparison of EMR and endoscopic submucosal dissection for en bloc resection of early esophageal cancers in Japan. Gastrointest Endosc. 2008;68:1066–72.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Wray A, Rice P, Love M. Endoscopic ultrasound in Barrett’s oesophagitis with dysplasia. Ulster Med J. 2012;81:70–3.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Memorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Esophageal Surgery Program, Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer CenterNew YorkUSA

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