Endoscopic therapy in Barrett's oesophagus

endoscopic therapy in Barrett's oesophagus

Endoscopic therapy can be divided into:

• tissue acquiring – e.g. - mucosal resection and endoscopic submucosal dissection
• non tissue acquiring or abalative therapy – e.g. - radiofrequency ablation, photodynamic therapy, cryotherapy, and argon plasma coagulation

Endoscopic mucosal resection

• endoscopic mucosal resection (EMR) is an minimally invasive procedure that involves the removal of flat and nodular lesions in Barrett’s oesophagus and early oesophageal adenocarcinoma that is limited to the mucosa.
• EMR is also used as the most accurate staging intervention for Barrett’s early neoplasia
• stricture formation is a complication

Radiofrequency ablation

• is the preferred endoscopic ablative therapy for flat dysplasia or intramucosal carcinoma.
• high frequency energy is delivered through an electrode which destroy the superficial lining of the oesophagus
• complications include - post-procedural chest pain (short term) and stricture formation (responsive to dilation)
• can be safely carried out even after previous endoscopic mucosal resection

Cryotherapy

• liquid carbon dioxide or nitrogen is applied to the affected dysplastic mucosa causing injury to the tissue. The tissue injury heals with formation of neosquamous epithelium.
• complications include- dysphagia, strictures, and chest pain

Photodynamic therapy

• no longer used due to high complication rate

Reference:

• (1) Pophali P, Halland M. Barrett's oesophagus: diagnosis and management. BMJ. 2016;353:i2373
• (2) Fitzgerald RC et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus. Gut. 2014;63(1):7-42