A narrative review of endoscopic therapies in Barrett’s esophagus

Abstract

: Endoscopic therapy has largely replaced esophagectomy in the management of neoplastic lesions [high grade dysplasia (HGD) and early cancer] in patients with Barrett’s esophagus (BE). This change has improved the cost of treatment and decreased patient’s morbidity while maintaining comparable efficacy to surgery. A multitude of endoscopic techniques (resective and ablative) exist to completely eradicate the Barrett’s segment. Resective modalities such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are mostly used for visible or nodular Barrett’s lesions. Ablative modalities, such as radiofrequency ablation (RFA), cryoablation, and argon plasma coagulation (APC), are used to treat flat Barrett’s lesions. These resective and ablative modalities can be used alone or in combination to yield high rates of eradication. While more head to head trials are still needed to compare current modalities, the choice of technique can depend on several factors including the lesion morphology, Barrett’s segment length, the circumferential BE extent, side effect profile of treatment, availability of tools, as well as the physician’s expertise. In this review, we discuss when BE lesions can and should be treated endoscopically, provide an overview and comparison of the available endoscopic treatment modalities, updated research on upcoming technologies, and how these therapies can be positioned to treat BE in different clinical settings.