Endoscopic versus surgical therapy for Barrett's esophagus neoplasia

Ioana Smith, Michel Kahaleh

Research output: Contribution to journalReview article

8 Scopus citations

Abstract

Esophagectomy has been the traditional therapy for high-grade dysplasia and intramucosal cancer. Though surgery can completely resect the cancer and the affected lymph nodes, it carries significant morbidity and mortality (often exceeds 2%). New developments in endoscopy have provided less-invasive therapies that can also be used to stage tissue invasion of cancer; they include esophageal mucosal resection (EMR) and endoscopic submucosal dissection. Additional endoscopic therapies include photodynamic therapy, radiofrequency ablation (RFA) and argon plasma coagulation. Combining EMR that targets the cancer and RFA that targets the surrounding Barrett's esophagus offers an alternative to the operative approach when there is no lymph node metastasis. Arguments for surgical esophagectomy include concern for missed lymph node metastasis and incomplete endoscopic resection. Based on EMR's high neoplasia eradication rate and its fewer and more manageable complications, EMR, especially when combined with RFA, appears to be a viable alternative to surgery in early submucosal cancers, that is, sm1.

Original languageEnglish (US)
Pages (from-to)31-35
Number of pages5
JournalExpert Review of Gastroenterology and Hepatology
Volume9
Issue number1
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

Keywords

  • Barrett's esophagus
  • conventional endoscopy
  • endoscopic mucosal resection
  • endoscopy
  • esophageal disease
  • esophagectomy
  • radiofrequency ablation

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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