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

Wani_Ablate in BE

Pdf Summary

Ablation has significantly changed the management of neoplasia in Barrett's esophagus (BE), providing a minimally invasive alternative to esophagectomy. It has been proven effective and safe through randomized controlled trials, observational studies, and population-based research. The goals of endoscopic eradication therapy (EET) include complete eradication of intestinal metaplasia (CE-IM), reduction of future neoplastic recurrence, and a long-term reduction in esophageal adenocarcinoma (EAC) mortality.<br /><br />The current approach to managing BE-related neoplasia has been shown to reduce the risk of progression to high-grade dysplasia or EAC by a significant margin. Real-world outcomes show that EET has lower rates of EAC recurrence and is feasible and scalable. However, there are still risks associated with the procedure, such as periprocedural complications and incomplete eradication of neoplasia.<br /><br />Recurrence rates of intestinal metaplasia and neoplasia post-EET vary across studies but generally show relatively low incidence rates. Adverse events associated with EET include strictures, bleeding, and perforation, with rates varying depending on the specific procedure performed.<br /><br />Comparative data comparing various approaches to EET are limited, but studies have shown no significant differences in neoplasia and IM rates or recurrence rates of EAC or dysplasia between EMR + ablation and complete EMR of the entire BE segment. However, complete EMR has higher rates of adverse events.<br /><br />Based on ASGE guidelines, routine EMR of the entire BE segment is not recommended compared to EMR of the visible lesion followed by ablation of the remaining BE segment for BE patients with dysplasia and intramucosal carcinoma.<br /><br />Moving forward, improving risk stratification tools, identifying patients who will benefit most from different treatment approaches, enhancing therapy safety and effectiveness, personalizing therapy and surveillance post-EET, and maintaining high-quality standards are important areas of focus in managing BE-related neoplasia.

Keywords

ablation

neoplasia

Barrett's esophagus

esophagectomy

endoscopic eradication therapy

intestinal metaplasia

esophageal adenocarcinoma

high-grade dysplasia

periprocedural complications

recurrence rates