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

Wani_Ablate in BE

Pdf Summary

Ablation therapy has significantly changed the management of Barrett's esophagus (BE)-related neoplasia by providing a minimally invasive treatment option that avoids the risks associated with surgery. Numerous studies have demonstrated the efficacy, effectiveness, and safety of endoscopic eradication therapy (EET), and it is endorsed by GI society guidelines.<br /><br />The goals of EET are to completely eradicate intestinal metaplasia and reduce the risk of future neoplastic recurrence. The long-term goal is to reduce mortality from esophageal adenocarcinoma (EAC).<br /><br />Ablation therapy has been shown to reduce the risk of progression to high-grade dysplasia (HGD) or EAC, as well as the risk of progression to EAC alone. Real-world outcomes have demonstrated the feasibility and scalability of EET, with low recurrence rates and a lower risk of EAC compared to surveillance alone.<br /><br />However, there are risks associated with EET, including periprocedural complications, incomplete eradication of neoplasia, progression to invasive EAC, and recurrence rates. Adverse events, such as strictures, bleeding, and perforation, have been reported but are relatively low.<br /><br />Comparative studies have shown no significant differences in neoplasia rates or recurrence rates between EMR plus ablation and complete EMR of the entire Barrett's segment. However, complete EMR is associated with higher rates of adverse events.<br /><br />Based on ASGE guidelines, routine EMR of the entire Barrett's segment is not recommended compared to EMR of visible lesions followed by ablation in patients with dysplasia and intramucosal carcinoma (IMC).<br /><br />Moving forward, there is a need to improve risk stratification tools and identify patients who will benefit most from resection versus resection plus ablation. Efforts should also focus on making therapy safer and more effective, personalizing treatment and surveillance, and upholding established quality metrics in EET.

Keywords

Ablation therapy

Barrett's esophagus

Neoplasia

Endoscopic eradication therapy

Intestinal metaplasia

Esophageal adenocarcinoma

High-grade dysplasia

Periprocedural complications

Complete EMR

Intramucosal carcinoma