Endoscopic Resection for Barrett's Esophagus with High-Grade Dysplasia or Early Esophageal Adenocarcinoma

The incidence of esophageal adenocarcinoma continues to rise in the United States and Western Europe. With the introduction of screening and surveillance programs for Barrett's esophagus, the precursor of esophageal adenocarcinoma, early esophageal neoplasia is being recognized on an increasing basis. Esophagectomy is the current standard of care for patients found to have Barrett's esophagus with high-grade dysplasia or intramucosal carcinoma and determined to be at suitable risk for surgical intervention. The role of esophagectomy in such circumstances has been questioned, however, due to concerns of excessive operative morbidity or mortality and the potential for a negative impact on long-term quality of life. Endoscopic resection has been introduced as a means to stage early esophageal neoplasms and as curative therapy for mucosal tumors determined to be low risk for nodal metastasis or systemic spread, allowing preservation of the esophagus. This article reviews endoscopic resection for the management of early esophageal neoplasia, including preprocedural evaluation, appropriate patient selection, available techniques and results of recent clinical trials.