Endoscopic Local Therapy of High-Grade Dysplasia and Early Cancer in Barrett’s Esophagus. The Significance of Endoscopic Mucosal Resection, Photodynamic Therapy, and Thermal Techniques Local endoscopic therapy of early cancer and high-grade dysplasia in Barrett’s esophagus comprises three different methods: endoscopic mucosal resection (EMR), semi-selective, non-thermal photodynamic therapy (PDT), and thermal techniques such as KTP- or Neodymium-YAG-laser, argon-plasma coagulation or multipolar electrocoagulation. All endoscopic methods have low morbidity and mortality rates compared to esophageal resection and therefore are an attractive alternative treatment option. Endoscopic mucosal resection is the treatment of choice for all localizable and circumscribed lesions, because the resected specimen can be classified with regard to the histopathological grading, complete resection and submucosal involvement, especially in view of patients who are surgical candidates. PDT is the best local treatment option for multifocal, non-localizable or large superficial lesions, as large areas can be treated in a single therapeutic session. Thermal procedures are mainly auxiliary methods for the optimization of EMR or PDT. Overall, all three methods should be considered as complementary techniques, and combined therapeutic strategies seem to be useful.The short-term and intermediate results of our study appear to be promising in view of the high rates of complete local remission in combination with the low morbidity and mortality. Due to the preservation of the esophagus a major problem seem to be metachronous cancers and local recurrences. Whether the ablation of the whole Barrett’s segment in combination with pH-metry-adapted acid suppression can lower the rate of metachronous lesions or recurrences has to be answered in prospective trials. A conclusive evaluation of the local endoscopic therapy in comparison with surgical esophageal resection will only be possible with long-term results at a later stage.

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© 2001 S. Karger GmbH, Freiburg
2001
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