| Barrett's esophagus is a premalignant condition leading to adenocarcinoma. The standard surveillance is Seattle protocol involving biopsy at 1-2 cm intervals over 4 quadrants of the BE. The development of image enhanced endoscopy IEE allowed detailed endoscopic examination targeting at BE carcinoma. ASGE systematic review showed the sensitivity, NPV, and specificity for NBI diagnosis of BE dysplasia were 94.2%, 97.5% and 94.4% respectively. Endoscopic resection served as the standard treatment for BE dysplasia and intramucosal adenocarcinoma. For BE dysplasia and intramucosal carcinoma, endoscopic resection achieved excellent clinical outcomes and survival. For those with submucosal invasion, esophagectomy should be offered due to risk of lymph node metastasis. Endoscopic resection can be achieved by EMR cap technique EMR-C or multiband mucosectomy MBM. A randomized study comparing EMR-C and MBM reported that time for resection was lower in MBM than EMR-C. However, size of specimen was smaller for MBM, and most resected specimen were less than 20mm. Hence for early BE carcinoma > 20mm, endoscopic submucosal dissection ESD achieved significantly better en-bloc resection compared to EMR. Endoscopic ablation techniques targeting at thermal ablation to both dysplastic lesion and Barrett's esophagus. A randomized sham controlled study reported significantly higher complete eradication of Barrett's dysplasia compared to sham therapy. After endoscopic therapy, patients should be under close surveillance for recurrence of dysplasia and Barrett's esophagus. |
