Management of Nodular Neoplasia in Barrett’s Esophagus

Endoscopic resection has proven highly effective and safe in the removal of focal early neoplastic lesions in Barrett’s esophagus and is considered the cornerstone of endoscopic treatment. Several techniques are available for endoscopic resection in Barrett’s esophagus. The most widely used technique for piecemeal resection of early Barrett’s neoplasia is the ligate-and-cut technique. Newer techniques such as endoscopic submucosal dissection may also play a role in the treatment of neoplastic Barrett’s esophagus. Treatment of early Barrett’s neoplasia should be centralized and limited to expert centers with a high-volume load and sufficient expertise in the detection and treatment of esophageal neoplasia.

Key points

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Endoscopic resection is an important diagnostic and curative tool in the management of early neoplasia in Barrett’s esophagus.
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Endoscopic resection provides an adequate tissue specimen to enable optimal histologic assessment of risk factors for lymph node metastasis.
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Mucosal Barrett’s cancer and low-risk submucosal cancers have a minimal risk for lymph node metastasis, and local endoscopic treatment is therefore justified.
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Multiband mucosectomy is currently the most widely used technique for endoscopic resection of early Barrett’s neoplasia.