Endoscopic Treatment of High-Grade Dysplasia and Intramucosal Esophageal Adenocarcinoma

The endoscopic management of Barrett's esophagus (BE) has changed with the emergence of novel endoscopic technologies and new data informing the care of dysplastic BE and early adenocarcinoma. These changes include an expanded use of endoscopic ablative therapy as well new recommendations for surveillance intervals. For most patients with BE and high-grade dysplasia (HGD), endoscopic ablative therapy is the preferred treatment strategy. Ablation has consistently been shown to be effective, with less morbidity compared with surgery. The best approach to treatment of adenocarcinoma with submucosal invasion is not clear as relevant data are conflicting. Traditionally, submucosal invasion was a contradiction to endoscopic therapy of esophageal adenocarcinoma, but recent data suggest that both endoscopic resection with ablation and esophagectomy may be acceptable treatment options in some settings. At present, surveillance for patients with baseline HGD or intramucosal carcinoma is suggested every 3 months in the first year following complete eradication of intestinal metaplasia, every 6 months in the second year, and annually thereafter.