Treatment Options for Patients With Persistent Disease After Initial Endotherapy for Esophageal Neoplasia

Abstract

There are numerous treatment options for esophageal dysplasia and neoplasia. Initial endoscopic therapy is the standard of care for high-risk lesions of the esophagus. However, residual and recurrent disease may be seen after initial endoscopic treatment, and selection of the optimal salvage treatment may be critical in achieving cure. Patients may be high risk for esophagectomy after assessment of risk factors such as age, frailty, and nutritional status. A wide array of salvage endoscopic eradication therapies may also be available, but consideration should be given to the initial endoscopic treatment modality, patient related risk factors, and expertise at the regional center. Chemoradiation may also play a key role in treating high risk patients and should be planned in conjunction with surgery or endoscopic therapy. Multidisciplinary team care improves survival in high-risk patients with high-risk lesions. Consideration should be given to a multidisciplinary approach after the diagnosis of dysplastic and malignant esophageal disease.