ENDOSCOPIC MUCOSAL ABLATION FOR BARRETT’S ESOPHAGUS

Abstract

Barrett’s esophagus (BE) is characterized by replacement of the usual esophageal squamous epithelium with abnormal, intestinal-type columnar epithelium. BE predisposes patients to esophageal adenocarcinoma through a multistep carcinogenic process, which includes intestinal metaplasia, low- to high-grade dysplasia, and adenocarcinoma. Prevention of metachronous cancer recurrence warrants a multipronged therapeutic approach, including endoscopic removal of the dysplastic mucosa and endoscopic ablative therapy for Barrett’s mucosa. Currently, several therapeutic options are available, including radiofrequency ablation, cryotherapy, and argon plasma coagulation. A thorough understanding of device specifications and indications is essential to select the optimal treatment strategy for favorable treatment outcomes. This chapter discusses the indications for endoscopic ablation of BE, device selection, and procedural details.