TY - JOUR
T1 - High-grade dysplasia and intramucosal adenocarcinoma in Barrett's esophagus
T2 - The role of endoscopic eradication therapy
AU - Leggett, Cadman L.
AU - Prasad, Ganapathy A.
PY - 2012/7
Y1 - 2012/7
N2 - Purpose of review: Endoscopic eradication therapy is considered a well tolerated and effective alternative to esophagectomy for a select patient population with high-grade Barrett's esophagus and intramucosal adenocarcinoma. This review highlights the available eradication techniques (resection and ablation) with emphasis on factors that influence the choice of therapy. Recent findings: Long-term follow-up of patients treated with endoscopic eradication therapies demonstrates high rates of complete remission of dysplasia and intestinal metaplasia with overall survival comparable to patients treated surgically. Cohort studies also report that recurrence following successful ablation occurs in a significant proportion of patients, making careful surveillance an indispensable component following successful endoscopic therapy. Endoscopic eradication therapy is also effective for the treatment of recurrent dysplasia and intestinal metaplasia. Ablative therapies may lead to buried metaplasia in a small proportion of patients. The long-term clinical implications of buried metaplasia are unclear. Summary: Patients undergoing endoscopic eradication therapy should be enrolled in a comprehensive surveillance and staging program that offers both resection and ablative techniques. Complete remission of dysplasia and intestinal metaplasia can be achieved in the vast majority of patients undergoing endoscopic therapy. Surveillance should continue after treatment with close monitoring for recurrent dysplasia.
AB - Purpose of review: Endoscopic eradication therapy is considered a well tolerated and effective alternative to esophagectomy for a select patient population with high-grade Barrett's esophagus and intramucosal adenocarcinoma. This review highlights the available eradication techniques (resection and ablation) with emphasis on factors that influence the choice of therapy. Recent findings: Long-term follow-up of patients treated with endoscopic eradication therapies demonstrates high rates of complete remission of dysplasia and intestinal metaplasia with overall survival comparable to patients treated surgically. Cohort studies also report that recurrence following successful ablation occurs in a significant proportion of patients, making careful surveillance an indispensable component following successful endoscopic therapy. Endoscopic eradication therapy is also effective for the treatment of recurrent dysplasia and intestinal metaplasia. Ablative therapies may lead to buried metaplasia in a small proportion of patients. The long-term clinical implications of buried metaplasia are unclear. Summary: Patients undergoing endoscopic eradication therapy should be enrolled in a comprehensive surveillance and staging program that offers both resection and ablative techniques. Complete remission of dysplasia and intestinal metaplasia can be achieved in the vast majority of patients undergoing endoscopic therapy. Surveillance should continue after treatment with close monitoring for recurrent dysplasia.
KW - Barrett's esophagus
KW - cryotherapy
KW - endoscopic eradication therapy
KW - esophageal adenocarcinoma
KW - high grade dysplasia
KW - radiofrequency ablation
KW - survival
UR - http://www.scopus.com/inward/record.url?scp=84862293933&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84862293933&partnerID=8YFLogxK
U2 - 10.1097/MOG.0b013e328352b78a
DO - 10.1097/MOG.0b013e328352b78a
M3 - Review article
C2 - 22450896
AN - SCOPUS:84862293933
SN - 0267-1379
VL - 28
SP - 354
EP - 361
JO - Current Opinion in Gastroenterology
JF - Current Opinion in Gastroenterology
IS - 4
ER -