Clin Endosc.  2014 Jan;47(1):55-64.

Treatment of Dysplasia in Barrett Esophagus

• Aranda-Hernandez J
• Cirocco M
• Marcon N

Abstract

Barrett esophagus is recognized as a risk factor for the development of dysplasia and adenocarcinoma of the esophagus. Cancer is usually diagnosed at an advanced stage with a 5-year survival rate of 15%. Most of these patients present de novo and are not part of a surveillance program. Endoscopic screening with improvement in recognition of early lesions may change this pattern. In the past, patients diagnosed with dysplasia and mucosal cancer were best managed by esophagectomy. Endoscopic techniques such as endoscopic mucosal resection and radiofrequency ablation have resulted in high curative rates and a shift away from esophagectomy. This pathway is supported by the literature review of esophagectomies performed for mucosal disease, as well as pathologists' interpretation of endoscopic mucosal specimens, which document the low risk of lymph node metastasis. The role of endoscopic therapy for superficial submucosal disease continues to be a challenge.

Keyword

Barrett esophagus; Therapeutics; Dysplasia; Endoscopy; Endoscopic treatment

MeSH Terms

Adenocarcinoma
Barrett Esophagus*
Catheter Ablation
Endoscopy
Esophagectomy
Esophagus
Humans
Lymph Nodes
Mass Screening
Neoplasm Metastasis
Risk Factors
Survival Rate

Figure

• 

  Fig. 1 (A) Nodular lesion (0-IIa+IIb) 1 cm above the gastroesophageal junction. The reported histology was intramucosal adenocarcinoma involving the muscularis mucosae - M3. (B) Mucosal defect after multiband resection.

• 

  Fig. 2 (A) Nodular lesion (0-IIa+IIb) 1 cm above the gastroesophageal junction. The reported histology was intramucosal adenocarcinoma involving the muscularis mucosae - M3. (B) Mucosal defect after multiband resection.

• 

  Fig. 3 (A) Nonnodular long segment of Barrett esophagus. (B) HALO 360 device immediately after deflation. (C) Mucosa immediately post-application.

• 

  Fig. 4 (A) Tongue of Barrett esophagus. (B) Defect after HALO 90 ablation.

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