Endoscopic eradication therapy for Barrett's esophagus: Adverse outcomes, patient values, and cost-effectiveness

Endoscopic therapy for Barrett's esophagus (BE) aims to replace dysplastic BE epithelium with neosquamous epithelium to prevent and reduce the risk of progression to esophageal adenocarcinoma (EAC) and treat early-stage EAC. Various modalities of endotherapy of dysplastic BE are described. Although endoscopic therapy is safe and effective in treating subjects with intramucosal carcinoma (IMCa), high-grade dysplasia (HGD), and confirmed low-grade dysplasia (LGD), challenges to successful treatment are being recognized. Though adverse outcomes of endotherapy such as bleeding, perforation, pain, and stricture formation are observed, they are not common and can usually be treated medically or endoscopically. Patient values and preferences toward endoscopic therapy and the cost-effectiveness of these endoscopic approaches also have crucial implications for the selection of appropriate treatment and subsequent outcomes in patients with BE.