Endoscopic Management of Barrett’s Esophagus and Early Esophageal Neoplasia

2019 ◽  
Author(s):  
Amanpal Singh ◽  
Andrew J Bain ◽  
Ramon Rivera
Keyword(s):  
Esophageal Cancer ◽  
Radiofrequency Ablation ◽  
High Risk ◽  
Acid Reflux ◽  
Barrett Esophagus ◽  
Endoscopic Management ◽  
Early Esophageal Cancer ◽  
Esophageal Neoplasia ◽  
Risk Patients ◽  
Ablative Techniques

Gastroesophageal reflux disease is common in North America, affecting around 25% of the population. A small fraction of these patients develop Barrett esophagus and thus are at a risk of developing esophageal cancer. The progression of Barrett esophagus to esophageal cancer can be prevented with timely examinations and, when necessary, by performing treatments to eradicate it. This review describes the use of endoscopy techniques to diagnose and classify Barrett esophagus among high-risk patients and the use of ablative techniques in patients with dysplasia. The review also describes endoscopic resection techniques for early esophageal cancer, which can provide staging information as well as can be therapeutic in selected cases. This review contains 8 figures and 49 references. Key Words: acid reflux, Barrett esophagus, cryoablation, endoscopic mucosal resection, endoscopic submucosal dissection, esophageal cancer, esophagus ablation, GERD, radiofrequency ablation

Endoscopic Management of Barrett’s Esophagus and Early Esophageal Neoplasia

2019 ◽  
Author(s):  
Amanpal Singh ◽  
Andrew J Bain ◽  
Ramon Rivera
Keyword(s):  
Esophageal Cancer ◽  
Radiofrequency Ablation ◽  
High Risk ◽  
Acid Reflux ◽  
Barrett Esophagus ◽  
Endoscopic Management ◽  
Early Esophageal Cancer ◽  
Esophageal Neoplasia ◽  
Risk Patients ◽  
Ablative Techniques

Gastroesophageal reflux disease is common in North America, affecting around 25% of the population. A small fraction of these patients develop Barrett esophagus and thus are at a risk of developing esophageal cancer. The progression of Barrett esophagus to esophageal cancer can be prevented with timely examinations and, when necessary, by performing treatments to eradicate it. This review describes the use of endoscopy techniques to diagnose and classify Barrett esophagus among high-risk patients and the use of ablative techniques in patients with dysplasia. The review also describes endoscopic resection techniques for early esophageal cancer, which can provide staging information as well as can be therapeutic in selected cases. This review contains 8 figures and 49 references. Key Words: acid reflux, Barrett esophagus, cryoablation, endoscopic mucosal resection, endoscopic submucosal dissection, esophageal cancer, esophagus ablation, GERD, radiofrequency ablation

scholarly journals Endoscopic Resection and Radiofrequency Ablation for Early Esophageal Neoplasia

2016 ◽  
Vol 34 (5) ◽  
pp. 469-475 ◽  
Author(s):  
Kamar Belghazi ◽  
Jacques Bergman ◽  
Roos E. Pouw
Keyword(s):  
Radiofrequency Ablation ◽  
Endoscopic Resection ◽  
Additional Treatment ◽  
Optimal Decision ◽  
Histological Evaluation ◽  
Endoscopic Management ◽  
Esophageal Neoplasia ◽  
Neoplastic Lesions ◽  
Barrett’S Mucosa ◽  
Barrett's Mucosa

Background: In the last few decades, endoscopic treatment of early neoplastic lesions in the esophagus has established itself as a valid and less invasive alternative to surgical resection. Endoscopic resection (ER) is the cornerstone of endoscopic therapy. Next to the curative potential of ER, by removing neoplastic lesions, ER may also serve as a diagnostic tool. The relatively large tissue specimens obtained with ER enable accurate histological staging of a lesion, allowing for optimal decision-making for further patient management. ER was pioneered in Japan, mainly for the resection of gastric lesions and squamous esophageal neoplasia, and also Western countries have been increasingly implementing ER in the treatment of early gastroesophageal neoplasia, mostly associated with Barrett's esophagus (BE). In BE, however, there is still a risk of metachronous lesions in the remainder of the Barrett's after focal ER. Additional treatment of all Barrett's mucosa is therefore advised. Currently, the most effective method for this is by using radiofrequency ablation (RFA). This review will provide an overview of indications for ER and RFA. Key Messages and Conclusions: Endoscopic management of early esophageal neoplasia is a safe and valid alternative to surgery and is nowadays the treatment of choice. ER is the mainstay of endoscopic management of early esophageal neoplasia since it allows for removal of neoplastic lesions and provides a large tissue specimen for histological evaluation. In case of early neoplasia in BE, focal ER should be complemented by eradication of the remaining Barrett's mucosa. RFA has proven to be a safe and effective modality to achieve complete eradication of Barrett's mucosa.

Advanced Esophageal Cancer in Patients who Underwent Radiofrequency Ablation for Barrett Esophagus with High-Grade Dysplasia

2013 ◽  
Vol 8 (1) ◽  
pp. 17-22 ◽  
Author(s):  
Min P. Kim ◽  
Kendra N. Brown ◽  
Mary R. Schwartz ◽  
Shanda H. Blackmon
Keyword(s):  
Esophageal Cancer ◽  
Radiofrequency Ablation ◽  
Delayed Diagnosis ◽  
Muscularis Propria ◽  
Normal Mucosa ◽  
Endoscopic Biopsy ◽  
High Grade Dysplasia ◽  
Barrett Esophagus ◽  
Resected Specimen ◽  
High Grade

Objective We sought to evaluate clinicopathologic features of patients who underwent esophageal surgery after radiofrequency ablation (RFA) treatment using the HALO system for Barrett esophagus (BE) with high-grade dysplasia (HGD). Methods We evaluated patients from our hospital database who underwent esophagectomy from August 2006 to January 2012 after previously receiving RFA for BE. Information on demographics, time between RFA and surgery, indications for surgery, and final esophageal pathology was collected. Results In our study, we selected 102 patients who underwent esophagectomy. Five patients had a history of RFA for BE with HGD. Three patients were referred because of persistent HGD despite RFA, and all three patients had HGD in the esophagectomy specimen. Two patients presented with a benign diagnosis (esophageal perforation and leiomyoma), and both of these patients had pathologic stage T3N2M0 adenocarcinoma of the esophagus in the resected specimen. One of these patients had normal mucosa overlying carcinoma in the muscularis propria and adventitia. The patients with stage T3N2M0 cancer did not have pre-RFA endoscopic ultrasound, first treatment of RFA with HALO360, or surveillance endoscopic biopsy every 3 months. Conclusions Radiofrequency ablation for BE with HGD may mask underlying esophageal cancer. Patients who are counseled to undergo RFA for HGD should be aware that RFA could lead to delayed diagnosis and delayed treatment of invasive esophageal cancer without careful patient selection, appropriate RFA use, and close surveillance.

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