title: Emerging Concepts for the Endoscopic Management of Superficial Esophageal Adenocarcinoma.
abstract: BACKGROUND
  Endoscopic therapy has revolutionized the treatment of Barrett's esophagus with high-grade dysplasia (HGD) or intramucosal adenocarcinoma by allowing preservation of the esophagus in many patients who would previously have had an esophagectomy. This paradigm shift initially occurred at high-volume centers in North America and Europe but now is becoming mainstream therapy. There is a lack of uniform guidelines and algorithms for the management of these patients. Our aim was to review important concepts and pitfalls in the endoscopic management of superficial esophageal adenocarcinoma.
  
  
  METHODS
  A small group colloquium consisting of gastroenterologists, surgeons, and pathologists reviewed published data and discussed personal and institutional experiences with endotherapy for HGD and superficial esophageal adenocarcinoma.
  
  
  RESULTS
  The group reviewed data and provided recommendations and management algorithms for seven areas pertaining to endoscopic therapy for Barrett's HGD and superficial adenocarcinoma: (1) patient selection and evaluation; (2) imaging and biopsy techniques; (3) devices; (4) indications for resection versus ablation; (5) ER specimen handling, processing, and pathologic evaluation; (6) patient care and follow-up after endoscopic therapy; and (7) complications of endoscopic therapy and treatment options.
  
  
  CONCLUSIONS
  Endoscopic therapy is preferred over esophagectomy for most patients with HGD or intramucosal adenocarcinoma, and may be applicable to select patients with submucosal tumors. Clear guidelines and management algorithms will aid physicians and centers embarking on endoscopic therapy and enable a standardized approach to the management of these patients that is applicable internationally.
authors.affiliation: Department of Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA, 90033, USA.
authors.forename: Christina L
authors.initials: CL
authors.lastname: Greene
authors.affiliation: Department of Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA, 90033, USA.
authors.forename: Stephanie G
authors.initials: SG
authors.lastname: Worrell
authors.affiliation: Department of Surgery, North Tyneside General Hospital, Durham University, Tyne and Wear, UK.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Attwood
authors.affiliation: Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
authors.forename: Parakrama
authors.initials: P
authors.lastname: Chandrasoma
authors.affiliation: Division of Gastroenterology and Hepatology, University of California, Irvine, Orange, CA, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Chang
authors.affiliation: Department of Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA, 90033, USA.
authors.forename: Tom R
authors.initials: TR
authors.lastname: DeMeester
authors.affiliation: Department of Surgery, Notre Dame University School of Medicine, Sydney, Sydney, Australia.
authors.forename: Reginald V
authors.initials: RV
authors.lastname: Lord
authors.affiliation: Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Montgomery
authors.affiliation: Gastroenterology and Interventional Endoscopy, St. John of God Hospital, Teaching Hospital of the University of Regensburg, Regensburg, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Pech
authors.affiliation: Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Vallone
authors.affiliation: Institute of Pathology, Klinikum Bayreuth, Preuschwitzerstr, Bayreuth, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Vieth
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Wang
authors.affiliation: Department of Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA, 90033, USA. stevenrdemeester@gmail.com.
authors.forename: Steven R
authors.initials: SR
authors.lastname: DeMeester
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D001471:Barrett Esophagus / Q000473:pathology* / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery*; D004945:Esophagoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D018579:Patient Selection; D011182:Postoperative Care; D013048:Specimen Handling
keywords: Endoscopic resection; Endotherapy; Esophageal adenocarcinoma; Esophagectomy