The field of Barrett’s esophagus ablation has come a long way since the original pioneering work of Brandt and Berenson in the early 1990s [1]
[2]. In fact, ablation is now viewed as a legitimate first-line treatment option for healthy patients with high grade dysplasia and early adenocarcinoma, based on studies performed to date. Furthermore, the notion of complete ablation of Barrett’s esophagus has moved from concept to reality. That being said, many questions about endoscopic ablation of Barrett’s esophagus remain unanswered. This section will try to address the following issues regarding the endoscopic ablation of Barrett’s esophagus:
Where have we been?
Where are we now?
What are currently unresolved issues in endoscopic ablation?
What are potential solutions for these issues?
References
1
Brandt L J, Kauvar D R.
Laser-induced transient regression of Barrett’s epithelium.
Gastrointest Endosc.
1992;
38
619-622
2
Berenson M M, Johnson T D, Markowitz N R. et al .
Restoration of squamous mucosa after ablation of Barrett’s esophageal epithelium.
Gastroenterology.
1993;
104
1686-1691
4
Ackroyd R, Brown N J, Davis M F. et al .
Photodynamic therapy for dysplastic Barrett’s oesophagus: a prospective, double blind, randomised, placebo controlled trial.
Gut.
2000;
47
612-617
8
Van Laethem J L, Peny M O. et al .
Intramucosal adenocarcinoma arising under squamous re-epithelialisation of Barrett’s oesophagus.
Gut.
2000;
46
574-577
9
Shand A, Dallal H, Palmer K. et al .
Adenocarcinoma arising in columnar lined oesophagus following treatment with argon plasma coagulation.
Gut.
2001;
48
580-581
10
Mino-Kenudson M, Ban S, Ohana M. et al .
Buried dysplasia and early adenocarcinoma arising in Barrett esophagus after porfimer-photodynamic therapy.
Am J Surg Pathol.
2007;
31
403-409
11
Krishnadath K K, Wang K K, Taniguchi K. et al .
Persistent genetic abnormalities in Barrett’s esophagus after photodynamic therapy.
Gastroenterology.
2000;
119
624-630
13
Hage M, Siersema P D, Vissers K J. et al .
Genomic analysis of Barrett’s esophagus after ablative therapy: persistence of genetic alterations at tumor suppressor loci.
Int J Cancer.
2006;
118
155-160
15
Pech O, Nagy C D, Gossner L. et al .
Photodynamic therapy of human Barrett’s cancer using 5-aminolaevulinic acid-induced protoporphyrin IX: an in-vivo dosimetry study in athymic nude mice.
Eur J Gastroenterol Hepatol.
2002;
14
657-662
16
Johnston C M, Schoenfeld L P, Mysore J V. et al .
Endoscopic spray cryotherapy: a new technique for mucosal ablation in the esophagus.
Gastrointest Endosc.
1999;
50
86-92
19
Prasad G A, Wang K K, Buttar N S. et al .
Long term survival following endoscopic and surgical treatment of high-grade dysplasia in Barrett’s esophagus.
Gastroenterology.
2007;
132
1226-1233
20
Das A, Singh V, Fleischer D E. et al .
A comparison of endoscopic treatment and surgery in early esophageal cancer: an analysis of surveillance epidemiology and end results data.
Am J Gastroenterol.
2008;
103
1340-1345
21
Kelty C J, Ackroyd R, Brown N J. et al .
Endoscopic ablation of Barrett’s oesophagus: a randomized-controlled trial of photodynamic therapy vs. argon plasma coagulation.
Aliment Pharmacol Ther.
2004;
20
1289-1296
22
Dulai G S, Jensen D M, Cortina G. et al .
Randomized trial of argon plasma coagulation vs. multipolar electrocoagulation for ablation of Barrett’s esophagus.
Gastrointest Endosc.
2005;
61
232-240
23
Sharma P, Wani S, Weston A P. et al .
A randomised controlled trial of ablation of Barrett’s oesophagus with multipolar electrocoagulation versus argon plasma coagulation in combination with acid suppression: long term results.
Gut.
2006;
55
1233-1239
24
Overholt B F, Lightdale C J, Wang K K. et al .
Photodynamic therapy with porfimer sodium for ablation of high-grade dysplasia in Barrett’s esophagus: international, partially blinded, randomized phase III trial.
Gastrointest Endosc.
2005;
62
488-498
25
Shaheen N J, Sharma P, Overholt B F. et al .
A randomized, multicenter, sham-controlled trial of radiofrequency ablation for subjects with Barrett’s esophagus containing dysplasia: interim results of the AIM dysplasia trial.
Gastroenterology.
2008;
134
A37
26
Overholt B F, Wang K K, Burdick J S. et al .
Five-year efficacy and safety of photodynamic therapy with Photofrin in Barrett’s high-grade dysplasia.
Gastrointest Endosc.
2007;
66
460-468
27
Ganz R A, Utley D S, Stern R A. et al .
Complete ablation of esophageal epithelium with a balloon-based bipolar electrode: a phased evaluation in the porcine and in the human esophagus.
Gastrointest Endosc.
2004;
60
1002-1010
28
Dunkin B J, Martinez J, Bejarano P A. et al .
Thin-layer ablation of human esophageal epithelium using a bipolar radiofrequency balloon device.
Surg Endosc.
2006;
20
125-130
29
Sharma V K, Wang K K, Overholt B F. et al .
Balloon-based, circumferential, endoscopic radiofrequency ablation of Barrett’s esophagus: 1-year follow-up of 100 patients.
Gastrointest Endosc.
2007;
65
185-195
30
Fleischer D E, Overholt B F, Sharma V K. et al .
Endoscopic ablation of Barrett’s esophagus: a multicenter study with 2.5-year follow-up.
Gastrointest Endosc.
2008;
Jun 16 [Epub ahead of print]
31
Ell C, May A, Pech O. et al .
Curative endoscopic resection of early esophageal adenocarcinomas (Barrett’s cancer).
Gastrointest Endosc.
2007;
65
3-10
32
Wang K K, Sampliner R E.
Practice Parameters Committee of the American College of Gastroenterology. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett’s esophagus.
Am J Gastroenterol.
2008;
103
788-797
33
Gondrie J J, Pouw R E, Sondermeijer C M. et al .
Effective treatment of early Barrett’s neoplasia with stepwise circumferential and focal ablation using the HALO system.
Endoscopy.
2008;
40
370-379
34
Gondrie J J, Pouw R E, Sondermeijer C M. et al .
Stepwise circumferential and focal ablation of Barrett’s esophagus with high-grade dysplasia: results of the first prospective series of 11 patients.
Endoscopy.
2008;
40
359-369
36
Dumot J A, Vargo J J, Zuccaro G. et al .
Results of cryospray ablation for esophageal high grade dysplasia (HGD) and intramucosal cancer (IMCA) in high risk non-surgical patients.
Gastrointest Endosc.
2008;
67
AB176
37
Seewald S, Akaraviputh T, Seitz U. et al .
Circumferential EMR and complete removal of Barrett’s epithelium: a new approach to management of Barrett’s esophagus containing high-grade intraepithelial neoplasia and intramucosal carcinoma.
Gastrointest Endosc.
2003;
57
854-859
38
Giovannini M, Bories E, Pesenti C. et al .
Circumferential endoscopic mucosal resection in Barrett’s esophagus with high-grade intraepithelial neoplasia or mucosal cancer. Preliminary results in 21 patients.
Endoscopy.
2004;
36
782-787
39
Peters F P, Kara M A, Rosmolen W D. et al .
Stepwise radical endoscopic resection is effective for complete removal of Barrett’s esophagus with early neoplasia: a prospective study.
Am J Gastroenterol.
2006;
101
1449-1457
40
Larghi A, Lightdale C J, Ross A S. et al .
Long term follow-up of complete Barrett’s eradication endoscopic mucosal resection (CBE-EMR) for the treatment of high grade dysplasia and intramucosal carcinoma.
Endoscopy.
2007;
39
1086-1091
41
Yoshinaga S, Gotoda T, Kusano C. et al .
Clinical impact of endoscopic submucosal dissection for superficial adenocarcinoma located at the esophagogastric junction.
Gastrointest Endosc.
2008;
67
202-209
42
Spechler S J, Sharma P, Traxler B. et al .
Gastric and esophageal pH in patients with Barrett’s esophagus treated with three esomeprazole dosages: a randomized, double-blind, crossover trial.
Am J Gastroenterol.
2006;
101
1964-1971
43
Sampliner R E, Camargo L, Fass R.
Impact of esophageal acid exposure on the endoscopic reversal of Barrett’s esophagus.
Am J Gastroenterol.
2002;
97
270-272
44
Kovacs B J, Chen Y K, Lewis T D. et al .
Successful reversal of Barrett’s esophagus with multipolar electrocoagulation despite inadequate acid suppression.
Gastrointest Endosc.
1999;
49
547-553
45
Hornick J L, Mino-Kenudson M, Lauwers G Y. et al .
Buried Barrett’s epithelium following photodynamic therapy shows reduced crypt proliferation and absence of DNA content abnormalities.
Am J Gastroenterol.
2008;
103
38-47
46
Ackroyd R, Brown N J, Stephenson T J. et al .
Ablation treatment for Barrett oesophagus: what depth of tissue destruction is needed?.
J Clin Pathol.
1999;
52
509-512
47
Leedham S J, Preston S L, McDonald S A. et al .
Individual crypt genetic heterogeneity and the origin of metaplastic glandular epithelium in human Barrett’s oesophagus.
Gut.
2008;
57
1041-1048
48
Weston A P, Sharma P, Banerjee S. et al .
Visible endoscopic and histologic changes in the cardia, before and after complete Barrett’s esophagus ablation.
Gastrointest Endosc.
2005;
61
515-521
49
Sampliner R E, Camargo E, Prasad A R.
Association of ablation of Barrett’s esophagus with high grade dysplasia and adenocarcinoma of the gastric cardia.
Dis Esophagus.
2006;
19
277-279
50
Fass R, Garewal H S, Hayden C W. et al .
Preferential repair by squamous epithelium of thermal induced injury to the proximal stomach in patients undergoing ablation of Barrett’s esophagus.
Gastrointest Endosc.
2001;
53
711-716
51
Fennerty M B, Corless C L, Sheppard B. et al .
Pathological documentation of complete elimination of Barrett’s metaplasia following endoscopic multipolar electrocoagulation therapy.
Gut.
2001;
49
142-144
52
Prasad G A, Wang K K, Halling K C. et al .
Utility of biomarkers in prediction of response to ablative therapy in Barrett’s esophagus.
Gastroenterology.
2008;
135
370-379