Abstract
Barrett esophagus (BE) is a common premalignant condition that may evolve from nondysplastic intestinal metaplasia to low-grade dysplasia (LGD), high-grade dysplasia (HGD), and ultimately to esophageal adenocarcinoma (EAC). This review addresses the range of endoscopic approaches for treating dysplastic BE and early EAC. Endoscopic treatment is favored for most patients with LGD, although endoscopic surveillance continues to be an alternative. Endoscopic eradication is definitively recommended for patients with HGD. Radiofrequency ablation is the preferred technique for ablation of dysplastic BE, although there is also strong support for endoscopic mucosal resection as a first-line therapy. Cryotherapy is emerging as a valid alternative ablative approach. Endoscopic resection by endoscopic mucosal resection or endoscopic submucosal dissection is recommended as the first-line therapy for nodular BE and T1a EAC. Post-eradication endoscopic surveillance is indicated at intervals that depend on the category of pretreatment dysplasia. Because of advances in endoscopic therapy, surgery is now indicated only when endoscopic ablation or resection has failed or in the setting of more advanced EAC. This review contains 8 figures, 2 tables, and 55 references. Key Words: cryotherapy, endoscopic mucosal resection, esophageal adenocarcinoma, esophagectomy, high-grade dysplasia, low-grade dysplasia, nodular Barrett esophagus, radiofrequency ablation
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