ASGE Annual GI Advanced Practice Provider Course - Day Two (On-Demand) | April 2022-21_Barretts Esophagus_Endotherapy

21_Barretts Esophagus_Endotherapy - Kaul

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This document provides an overview of the ASGE Annual Advanced Practice Provider (APP) Course on Barrett's Esophagus Endotherapy, presented by Dr. Vivek Kaul. The objectives of the course include identifying which patients with Barrett's esophagus should be treated, differentiating between patients who can be effectively treated with endoscopic therapy versus surgery, and reviewing the limitations of current therapeutic regimens. Barrett's esophagus is defined as the presence of at least 1cm of Columnar Lined Epithelium (CLE) and Specialized Intestinal Metaplasia (SIM). It is a precancerous condition, with an annual risk of progression to esophageal adenocarcinoma of 0.3% per year.<br /><br />The management of Barrett's esophagus depends on the presence of dysplasia. Surveillance is recommended for patients with indefinite or low-grade dysplasia, as well as non-dysplastic Barrett's esophagus. Endoscopic eradication therapy is indicated for patients with high-grade dysplasia, T1a esophageal adenocarcinoma, and T1b SM1 esophageal adenocarcinoma. Surgery may be considered for patients with T1b SM1 esophageal adenocarcinoma or higher stage pathology.<br /><br />The course reviews various endoscopic techniques for Barrett's esophagus endotherapy, including endoscopic mucosal resection (EMR), radiofrequency ablation (RFA), cryotherapy, and endoscopic submucosal dissection (ESD). RFA is an effective and widely used technique, with high rates of complete eradication of dysplasia and specialized intestinal metaplasia. Cryotherapy is another option, especially for patients who are not surgical candidates or who have failed other modalities. Complications of endotherapy include bleeding, perforation, delayed perforation, chest pain, and esophageal strictures.<br /><br />Surveillance is important after endoscopic eradication therapy to monitor for recurrences. Patients with Barrett's esophagus confirmed by an expert pathologist have a significantly higher risk of progression to high-grade dysplasia and esophageal adenocarcinoma. Multidisciplinary team approach involving experienced endoscopists, thoracic surgeons, GI pathologists, and APPs is crucial for the management of Barrett's esophagus.<br /><br />Overall, the course emphasizes the importance of individualized treatment plans based on the patient's pathology, anatomy, and compliance. APPs play a significant role in the assessment, management, and follow-up of patients with Barrett's esophagus, including facilitating GI tumor board discussions and participating in clinical research.

Keywords

ASGE Annual Advanced Practice Provider Course

Barrett's Esophagus Endotherapy

Dr. Vivek Kaul

Barrett's esophagus treatment

Endoscopic therapy

Surgery

Therapeutic regimens

Dysplasia surveillance

Endoscopic eradication therapy

Endoscopic techniques