Endotherapy is now the mainstay of therapy for Barrett's associated neoplasia. The approach should begin with confirmation of neoplasia by a gastrointestinal pathologist, patient counseling, and appropriate endoscopic work up. Detailed examination with high-resolution white light endoscopy is the most important tool for detection of neoplasia. Further validation studies are needed for many enhanced imaging modalities before being recommended as part of the standard work up and assessment of patients with Barrett's esophagus (BE). Endoscopic mucosal resection is required for any visible lesion in the setting of dysplasia for accurate histological diagnosis. The remainder of the epithelium may be treated with resection or ablative therapy, followed by adequate surveillance. Patients with non-dysplastic Barrett's require further risk stratification before incorporation of ablative therapy for this population. The future will fortify the endoscopic role in Barrett's with validation trials for endoscopic assessment, further long-term results for each of the treatment modalities, potential risk stratification for patients with BE, and improved guidelines for surveillance after therapy.
1 Section of Gastroenterology, Center for Endoscopic Research and Therapeutics, University of Chicago Medical Center, Chicago, Illinois, USA
Correspondence: Irving Waxman, MD, The Center for Endoscopic Research and Therapeutics (CERT), University of Chicago, 5758 South Maryland Avenue, MC 9028, Chicago, Illinois 60637, USA. E-mail: email@example.com
Received 22 November 2011; accepted 21 February 2012
published online10 April 2012