ASGE Annual Postgraduate Course: Clinical Challenges and Real-Time Decision Making in GI Endoscopy (Live and Virtual) | May 2023-Draganov

Draganov_Barretts Cut vs Ablate Debate

Pdf Summary

The document discusses the current algorithm for the therapy of dysplastic/neoplastic Barrett's Esophagus (BE). The first step involves the removal of all visible mucosal irregularities through endoscopic resection, typically using EMR (endoscopic mucosal resection). The second step is the ablation of the remaining flat Barrett's epithelium, usually done with RFA (radiofrequency ablation). However, there are downsides to ablation, such as the burden on the patient, multiple sessions required, and potential complications.<br /><br />One significant issue with ablation is its high recurrence rate. Pre-procedure staging techniques are also not perfect, including EGD with high-definition endoscopes, advanced imaging, chromoendoscopy, and various biopsy methods. The lack of final definitive pathology further complicates the situation.<br /><br />EMR, despite its disadvantages, is considered acceptable due to providing post-procedure tissue diagnosis and staging, although it still leaves uncertainty. ESD (endoscopic submucosal dissection) is another option with advantages such as en-bloc resection and lower recurrence compared to EMR. It is suitable for larger lesions, those with potential submucosal invasion, or lesions arising after ablation.<br /><br />The current algorithm emphasizes the importance of removing all visible irregularities through endoscopic resection, expanding the role of ESD alongside EMR. Ablation options are expanding beyond RFA to include cryoablation and hybrid APC (argons plasma coagulation).<br /><br />In summary, the document highlights the challenges and limitations of ablation in the treatment of dysplastic/neoplastic Barrett's Esophagus. It suggests a combination of endoscopic resection and ablation techniques to achieve optimal outcomes, with ESD being a useful technique for certain cases.

Keywords

dysplastic/neoplastic Barrett's Esophagus

therapy

algorithm

endoscopic resection

EMR

ablation

RFA

recurrence rate

pre-procedure staging techniques

ESD