Barrett ’s Esophagus: When to Scope and When to Ablate

AbstractPurpose of reviewBarrett ’s esophagus (BE) is an acquired condition caused by chronic gastroesophageal reflux disease which can progress to esophageal adenocarcinoma (EAC). This paper discusses different sampling approaches, endoscopic surveillance techniques, endoscopic eradication therapies, as well as the future of BE diagnosis and management.Recent findingsAdequate inspection with high-definition white light and chromoendoscopy, as well as adherence to the Seattle biopsy protocol, is recommended for BE surveillance. Chromoendoscopy includes dye-based and electronic techniques, with narrow band imaging now being the generally preferred and more commonly used form of chromoendoscopy. Chromoendoscopy-directed biopsies should not replace the Seattle protocol, but may enhance detection of neoplasia. Radiofrequency ablation (RFA) has the greatest range of efficacy and safety data, with long-term follow-up data showing that recurrences post-RFA are rare. Studies on hybrid argon plasma coagulation and cryoablation are showing comparable efficacy rates; however, randomized control trials are not currently available to compare outcomes with RFA. Data is accruing on non-endoscopic screening tools, artificial intelligence techniques for detection of neoplasia, and biomarkers for BE risk stratification.SummaryWhile there is debate regarding the efficacy of BE surveillance, all gastrointestinal societies currently recommend surveillance. Ablative therapy is recommended for BE...
Source: Current Treatment Options in Gastroenterology - Category: Gastroenterology Source Type: research