Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection for Endoscopic Therapy of Barrett’s Esophagus-related Neoplasia

A major paradigm shift has occurred in the management of dysplastic Barrett’s esophagus (BE) and early esophageal carcinoma. Endoscopic therapy has now emerged as the standard of care for this disease entity. Endoscopic resection techniques like endoscopic mucosal resection and endoscopic submucosal dissection combined with ablation techniques help achieve long-term curative success comparable with surgical outcomes, in this subgroup of patients. This article is an in-depth review of these endoscopic resection techniques, highlighting their role and value in the overall management of BE-related dysplasia and neoplasia.

Key points

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Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are indispensable endoscopic resection (ER) interventions in patients with dysplastic Barrett’s esophagus (BE) and esophageal adenocarcinoma, having diagnostic (staging) and therapeutic (curative) value.
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ER interventions are frequently combined with endoscopic ablation to manage dysplastic BE.
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For mucosal (HGD and T1a) disease, continued endoscopic management is recommended.
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For T1b (submucosal involvement) or higher stage, esophagectomy is still the standard of care.
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ER is the most accurate intervention that helps with the above stratification.