Role of mucosal ablative therapy in the treatment of the columnar-lined esophagus

Rodney J. Pacifico, Kenneth Ke Ning Wang

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

With the high prevalence of gastroesophageal reflux-like symptoms in the United States and the association between GERD symptoms and the premalignant condition of BE, there is more and more demand for new and efficacious techniques to treat BE. A wide variety of endoscopic mucosal ablative techniques have been developed with promising initial results. Long-term control of neoplastic risk, however, has not been demonstrated, and most studies demonstrate that there is still potentially some intestinal mucosa present underneath squamous mucosa. Currently, more study is needed to determine which patient groups require therapy of any kind and to determine which therapies would be the most efficacious. Genetic markers may aid in identification of subgroups that are at risk for cancer and help to identify those who would respond to mucosal therapy. Even in patients who have HGD, subgroups of patients who have focal HGD have been found to have better prognosis than those who have more widespread HGD. Currently, there is sufficient information to consider mucosal ablative techniques in patients who are not good surgical candidates. Photodynamic therapy, APC, KTP, Nd:YAG and argon lasers, MPEC, and EMR may provide good alternatives, depending on the degree of dysplasia, the extent of disease, and the age of the patient. Photodynamic therapy and Nd:YAG laser therapy have been applied to more neoplastic lesions, whereas KTP:YAG, APC, and multipolar coagulation have been successful in nondysplastic Barrett's mucosa. In the future, there will be more information to justify the application of mucosal ablative therapy in selected patients.

Original languageEnglish (US)
Pages (from-to)185-203
Number of pages19
JournalChest Surgery Clinics of North America
Volume12
Issue number1
DOIs
StatePublished - 2002

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Esophagus
Solid-State Lasers
Photochemotherapy
Gastroesophageal Reflux
Mucous Membrane
Therapeutics
Argon
Laser Therapy
Intestinal Mucosa
Group Psychotherapy
Genetic Markers
Neoplasms

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Role of mucosal ablative therapy in the treatment of the columnar-lined esophagus. / Pacifico, Rodney J.; Wang, Kenneth Ke Ning.

In: Chest Surgery Clinics of North America, Vol. 12, No. 1, 2002, p. 185-203.

Research output: Contribution to journalArticle

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