Can endoscopic resection for Barrett's dysplasia and early cancer be curative?

Abstract

Effective endoscopic treatments for dysplasia and early (intramucosal) cancer, together with expanded and rigorous screening programs to detect Barrett's esophagus, could help reverse the increase in the incidence of esophageal cancer and reduce esophageal cancer-related mortality. In this review, we discuss the long-term outcomes for mucosal resection for dysplasia and early cancer and compares them to esophagectomy as the standard of care choice. Eendoscopic resection for Barrett's dysplasia and early cancer can be curative but only when the lesion can be classified as: Paris type I (polypoid); Paris IIa (slightly elevated); Paris IIb (flat); Paris IIc (slightly depressed); histological grades G1 and G2; high-grade dysplasia. The size of the lesion is important, since <20mm diameter lesions can be removed using endoscopic mucosal resection or, if they are larger, by endoscopic submucosal dissection. Proper imaging and lesion characterization followed by endoscopic resection as needed are essential in diagnostic and therapeutic decision making. Mucosal (T1a) Barrett's cancer and low-risk submucosal cancers have a minimal risk for lymph node metastasis and local endoscopic treatment is justified. Long-term outcomes of endoscopic therapy are same as surgery.