Limitations of endoscopic ablation in Barrett’s esophagus

Abstract

In the last 5–10 years, endoscopic ablative therapies have been gaining ground as treatment for Barrett’s esophagus associated with high-grade dysplasia and early cancer, and they are becoming the most preferred technique over surgery as the standard of care. These therapies are associated with a lower rate of complications and mortality than surgery; studies have found them to be safe, effective and tolerable. Endoscopic ablative therapies are not, however, without their drawbacks. There is a paucity of data on long-term efficacy, and direct comparisons of the different modalities are lacking. Unlike surgery, current data suggest that endoscopic ablation treatments may not be curative in all patients, so patients require ongoing surveillance and acid suppression. Questions remain regarding durability as well as factors promoting recurrence after endoscopic therapy. The authors conducted a systematic review of the literature on ablative therapies in Barrett’s esophagus to describe the modalities currently available and to provide an understanding of their limitations.

Keywords:

• ablation therapies
• Barrett’s esophagus
• cryoablation
• limitations of ablation therapy
• photodynamic therapy
• radiofrequency ablation
• recurrences in ablation therapy

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Endoscopic ablation is the preferred treatment for patients with Barrett’s esophagus and associated high-grade dysplasia.

• Ablation techniques are well tolerated and have been associated with low complication rates.

• Although these techniques produce excellent short-term results, their durability is still questionable. This necessitates continued surveillance and acid suppression.

• With recent 5-year follow-up studies showing increased recurrence rates of the dysplastic epithelium and the presence of subsquamous dysplasia, there is a need for long-term studies looking at the efficacy and durability of these procedures.