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Endoscopic management of Barrett esophagus

Nature Reviews Gastroenterology & Hepatology volume 8, pages 582–591 (2011)Cite this article

Subjects

Abstract

Endoscopy has a vital role in the diagnosis, screening, surveillance and treatment of Barrett esophagus. Over the past few decades, tremendous advances have been made in endoscopic technology, and the management of dysplasia and early cancer in Barrett esophagus has changed radically from being surgical to organ-sparing endoscopic therapy. Proper endoscopic techniques and systematic biopsy protocols improve dysplasia detection, and endoscopic surveillance improves outcomes in patients with Barrett esophagus and dysplasia. Endoscopic treatment can be tissue acquiring (as in endoscopic mucosal resection and endoscopic submucosal dissection) or ablative (as with photodynamic therapy, radiofrequency ablation and cryotherapy). Treatment is usually multimodal, combining endoscopic resection of visible lesions with one or more mucosal ablation techniques, followed by long-term surveillance. Such treatment is safe and effective. Shared decision-making between the patient and physician is important while considering treatment for dysplasia in Barrett esophagus. Issues such as durability of response, importance of subsquamous Barrett epithelium and the optimal management strategy in patients with low-grade dysplasia and nondysplastic Barrett esophagus need to be studied further. Development of safer wide-field resection techniques, which would effectively remove all Barrett esophagus and obviate the need for long-term surveillance, is needed.

Key Points

  • Rigorous surveillance with a systematic biopsy protocol improves detection of dysplasia and early cancer, and improves outcomes in patients with Barrett esophagus

  • Ablation of nondysplastic Barrett esophagus cannot be recommended based on existing data

  • Shared decision-making between the patient and physician is important while considering treatment for dysplasia in Barrett esophagus

  • A multimodal approach is recommended for treatment of Barrett esophagus, combining endoscopic resection of visible lesions followed by mucosal ablation

  • Radiofrequency ablation has been shown to be safe and effective for eradication of Barrett esophagus; long-term studies demonstrating durability of this treatment are awaited

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Figure 1: Schematic representation of the Prague criteria.
Figure 2: EMR of Barrett esophagus with HGD.
Figure 3: PDT for treatment of Barrett esophagus with intramucosal cancer.
Figure 4: Treatment of Barrett esophagus with RFA.
Figure 5

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  1. Division of Gastroenterology, University Hospitals Case Medical Center, Case Western Reserve University, Wearn 247, 11100 Euclid Avenue, Cleveland, 44106, OH, USA

    Aparna Repaka & Amitabh Chak

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A. Repaka and A. Chak contributed equally to all aspects of this Review.

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Repaka, A., Chak, A. Endoscopic management of Barrett esophagus. Nat Rev Gastroenterol Hepatol 8, 582–591 (2011). https://doi.org/10.1038/nrgastro.2011.151

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