Regression of childhood Barrett's esophageal mucosa by antireflux surgery and bipolar electrocoagulation

Endoscopic ablation of Barrett's esophagus

Barrett's esophagus is a premalignant lesion of the esophagus that arises as an abnormal tissue response to epithelial injury from gastroesophageal reflux. Barrett's esophagus has previously been considered an irreversible lesion that required life-long surveillance to prevent malignant transformation. Recently, combination therapy with pharmacologic or surgical control of acid reflux combined with endoscopic delivery of a mucosal injury appears to have the capability of reversing superficial Barrett's tissue, and perhaps deeper tissue as well. Whether Barrett's esophagus is cured and cancer/dysplasia prevented by these techniques will require long-term follow-up of these patients.

Endoscopic ablation therapy for Barrett's esophagus with high-grade dysplasia: a review

Besides esophagectomy and antireflux therapy with intensive endoscopic surveillance, endoscopic ablation therapy is a new treatment modality for Barrett's esophagus (BE) with high-grade dysplasia (HGD). Endoscopic surgical ablation can be performed by either a thermal, chemical, or mechanical method. This article describes the current management of patients with BE and HGD and the various methods of endoscopic ablation, including multipolar electrocoagulation, argon plasma beam coagulation, contact laser photoablation, and photodynamic therapy. It also summarizes the results of 37 patient studies, case reports, and abstracts on experimental endoscopic therapies for BE. The advantages and disadvantages of the various treatment possibilities are considered, and the future direction of the management of BE is discussed.