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

Video Transcription

Video Summary

The video features a debate between Dr. Sachin Wani and Dr. Peter Draganov on the topic of the primary treatment modality for patients with Barrett's esophagus related neoplasia. Dr. Wani argues in favor of ablation, while Dr. Draganov presents a contrasting viewpoint. Dr. Wani emphasizes that endoscopic eradication therapy has revolutionized the management of Barrett's esophagus, offering a minimally invasive approach that avoids the morbidity of esophagectomy. He presents evidence from randomized controlled trials, observational data, population-based studies, and guidelines endorsing the efficacy, effectiveness, and safety of ablation. Dr. Wani also discusses the importance of setting goals for endoscopic eradication therapy, including achieving eradication of intestinal metaplasia, reducing neoplastic recurrences, and ultimately reducing esophageal cancer mortality. He proposes ground rules for the debate and stresses the need to consider all risks and benefits when choosing between ablation and resection. Dr. Draganov counters by highlighting the downsides of ablation, such as burden to the patient, multiple sessions, post-procedure pain, and complications. He also argues that ablation carries a higher risk of recurrence compared to his own recommended approach of endoscopic resection, such as EMR and ESD. Dr. Draganov emphasizes the importance of accurate tissue diagnosis and histopathologic assessment, which he believes are compromised with ablation. He suggests that ESD should be considered for larger lesions, depressed lesions, suspected superficial intermucosal cancer, equivocal histology, positive margin or recurrent lesions post-ablation, while recognizing the technical complexity and higher complication rate of ESD. Both speakers discuss the evolving approach to managing Barrett's esophagus and the expanding options available.

Asset Subtitle

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

Keywords

Barrett's esophagus

neoplasia

ablation

endoscopic eradication therapy

esophagectomy