Selected commentary to “Treatment of Barrett’s esophagus with a novel focal cryoablation device: a safety and feasibility study”
Barrett’s esophagus (BE) is caused by gastroesophageal reflux disease (GERD) and harbors an increased risk for esophageal cancer. Via a sequence involving low- (LGD) and high-grade dysplasia (HGD), esophageal adenocarcinoma may develop (annual cancer risk: 0.1–0.7 %). Indefinite for dysplasia (ID) defines a condition where the presence or absence of dysplasia cannot be accurately assessed, due to inflammatory changes in the mucosa. Re-endoscopy and biopsy sampling is recommended after a 3–4 weeks course of double dose proton pump inhibitor (PPI) therapy p.o. (i.e. 2 × 40 mg PPI). Diagnosis of BE is established if biopsies obtained from endoscopically visible segments, tongues or islands of columnar lined esophagus (CLE) contain goblet cells ± LGD, HGD or cancer.
Conceptually the elimination of BE aims to stop the progression to cancer or to prevent early cancer from getting more invasive. Thus ablation should foster cancer prevention and avoid the need for surgical resection, which represents the therapy in more advanced tumor stages. Basically removal of BE can be achieved by endoscopic mucosal resection (EMR), laser energy-, radiofrequency energy- or cryo-energy based ablation.