Endoscopic resection for patients with mucosal adenocarcinoma of the esophagus.

ABSTRACT

Due to its rapidly increasing incidence in the last decade, esophageal adenocarcinoma has been attracting widespread interest among gastroenterologists all over the world. Advanced adenocarcinomas arising from intestinal metaplasia in the esophagus (Barrett's esophagus, BE) are associated with a poor prognosis when esophagectomy is required. In addition to high mortality rates, there is a significant morbidity rate among patients who undergo surgery. However, if cancer can be diagnosed at an early stage, the endoscopic treatment options that are available significantly reduce the mortality rates. International guidelines recommend that endoscopic treatment should be carried out in all patients with mucosal cancer and low-risk criteria, but the method of choice for resection has been a matter of continuing debate. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection are the main techniques competing in this field. Endoscopists also have to be able to manage potential complications and need to know how to deal with recurrences. Finally, it is essential to treat nondysplastic BE as an important part of the treatment, in order to avoid metachronous neoplasia. Different methods of ablative treatment, such as argon plasma coagulation and radiofrequency ablation (RFA), have been included in the subsequent treatment after resection. This review introduces and evaluates the different resection methods and discusses ablative therapy and surveillance protocols. The major scientific databases (Medline / PubMed) were searched for diagnoses and treatment in early esophageal adenocarcinoma. The current literature and the latest national and international guidelines were also included in order to obtain a good overview of the field. In areas in which there is a low quality of evidence, such as poor healing after endoscopic treatment, the authors offer recommendations based on their own experience in this field.