Endoprevention of esophageal cancer: Endoscopic ablation of Barrett's metaplasia and dysplasia

Herbert C. Wolfsen

Research output: Contribution to journalReview article

16 Scopus citations

Abstract

This review describes the use of endoscopic therapy for the treatment of Barrett's disease and the prevention of esophageal carcinoma, predominantly a disease of older white men. While the term endoprevention may be novel, gastroenterologists have been using endoscopic techniques to prevent colon cancer for decades. For the endoprevention of Barrett's carcinoma, the regulatory approval for the use of porfimer sodium photodynamic therapy was an important milestone, as this treatment has been proven to safely ablate Barrett's glandular epithelium, including high-grade dysplasia, and significantly decrease the risk for the development of invasive cancer in several single-center studies, a prospective multicenter randomized controlled study using expert centralized histopathology analysis and long-term single-center results. Newer methods of mucosal ablation, such as the radiofrequency balloon, have been developed for the treatment of patients with Barrett's metaplasia or dysplasia. These newly developed techniques are able to treat large fields of glandular epithelium in a short treatment procedure using safe, effective, durable methods for the complete ablation of Barrett's metaplasia and low-grade dysplasia. These techniques may finally allow the interventional gastrointestinal endoscopist to prevent the development of esophageal carcinoma, just as colonoscopy with polypectomy has prevented colon cancer. However, it will be critically important to document the safely, durability and efficacy of these devices. Ultimately, the impact of successful Barrett's ablation on the incidence of Barrett's carcinoma, and the need for postablation surveillance endoscopy must be determined.

Original languageEnglish (US)
Pages (from-to)713-723
Number of pages11
JournalExpert review of medical devices
Volume2
Issue number6
DOIs
StatePublished - Nov 2005

Keywords

  • Argon beam coagulation
  • Cryoablation
  • Endoscopic mucosal resection
  • Multipolar electrocoagulation
  • Photodynamic therapy
  • Porfimer sodium
  • Radiofrequency ablation

ASJC Scopus subject areas

  • Surgery
  • Biomedical Engineering

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