Endoprevention of esophageal cancer: endoscopic ablation of Barrett's metaplasia and dysplasia.
This review describes the use of endoscopic therapy for the treatment of Barrett's disease and the prevention of esophageal carcinoma, predominantly a disease of older white men. While the term endoprevention may be novel, gastroenterologists have been using endoscopic techniques to prevent colon cancer for decades. For the endoprevention of Barrett's carcinoma, the regulatory approval for the use of porfimer sodium photodynamic therapy was an important milestone, as this treatment has been proven to safely ablate Barrett's glandular epithelium, including high-grade dysplasia, and significantly decrease the risk for the development of invasive cancer in several single-center studies, a prospective multicenter randomized controlled study using expert centralized histopathology analysis and long-term single-center results. Newer methods of mucosal ablation, such as the radiofrequency balloon, have been developed for the treatment of patients with Barrett's metaplasia or dysplasia. These newly developed techniques are able to treat large fields of glandular epithelium in a short treatment procedure using safe, effective, durable methods for the complete ablation of Barrett's metaplasia and low-grade dysplasia. These techniques may finally allow the interventional gastrointestinal endoscopist to prevent the development of esophageal carcinoma, just as colonoscopy with polypectomy has prevented colon cancer. However, it will be critically important to document the safety, durability and efficacy of these devices. Ultimately, the impact of successful Barrett's ablation on the incidence of Barrett's carcinoma, and the need for postablation surveillance endoscopy must be determined.
Wolfsen
Herbert C
HC
Mayo Clinic, Division of Gastroenterology and Hepatology, 6A Davis Building, 4500 San Pablo Road, Jacksonville, FL 32224, USA. pdt@mayo.edu
D001471:Barrett Esophagus / Q000150:complications / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D017115:Catheter Ablation / Q000295:instrumentation*; D002986:Clinical Trials as Topic; D020776:Endoscopes, Gastrointestinal; D004867:Equipment Design; D004938:Esophageal Neoplasms / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D010778:Photochemotherapy / Q000379:methods*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011230:Precancerous Conditions / Q000601:surgery*; D013673:Technology Assessment, Biomedical; D016896:Treatment Outcome