ASGE Annual Postgraduate Course: Clinical Challenges and Real-Time Decision Making in GI Endoscopy (Live and Virtual) | May 2023-Session 2 Debate

Video Transcription

Video Summary

The video features a debate between Dr. Sachin Wani from the University of Colorado and Dr. Peter Draganov regarding the optimal treatment modality for patients with Barrett's esophagus-related neoplasia. Dr. Wani argues in favor of ablation as the primary treatment, while Dr. Draganov presents an alternative viewpoint. Dr. Wani highlights that endoscopic eradication therapy has revolutionized the management of these patients by offering a minimally invasive approach and reducing the risk of complications associated with esophagectomy. He emphasizes that there is extensive evidence, including randomized controlled trials and population-based data, supporting the efficacy, effectiveness, and safety of ablation. Dr. Wani outlines the principles of endoscopic eradication therapy, including resection of visible lesions and ablation of the remaining Barrett segment. He also discusses the importance of setting appropriate goals for treatment, including complete eradication of intestinal metaplasia, reducing neoplastic recurrences, and ultimately reducing esophageal cancer mortality. Dr. Wani acknowledges the risks and benefits of ablation and resection, and presents an evidence-based approach to address these concerns. He provides data showing the effectiveness and durability of ablation and emphasizes the safety of the current approach. He concludes by discussing the ASGE guidelines, which recommend resection followed by ablation for Barrett's esophagus-related neoplasia. Dr. Draganov counters by raising concerns about the burden to patients, potential complications, and the issue of recurrence with ablation. He also highlights the limitations of diagnosis and the need for accurate histopathologic assessment. He argues for considering endoscopic submucosal dissection (ESD) as an alternative for certain cases, such as larger lesions and those with potential submucosal invasion. The video suggests that the current approach to managing patients with Barrett's esophagus-related neoplasia involves removing visible irregularities with endoscopic resection and ablating the remaining Barrett's segment, primarily with radiofrequency ablation (RFA). It emphasizes the importance of individualized treatment decisions based on risk stratification and the need for ongoing research to improve outcomes. The debate highlights the ongoing challenges and evolving nature of managing Barrett's esophagus-related neoplasia.

Asset Subtitle

Sachin B. Wani, MD, FASGE and Peter V. Draganov, MD, FASGE

Keywords

Barrett's esophagus-related neoplasia

ablation

endoscopic eradication therapy

esophagectomy

intestinal metaplasia