The role of endoscopic resection and ablation therapy for early lesions

Endoscopic resection (ER) has gained more and more importance in the treatment of early neoplastic lesions in Barrettʹs oesophagus over the last few years. The choice of the different available techniques depends on the site, the macroscopic type of the tumour and the personal experience of the endoscopist. The ‘suck-and-cut’ technique with ligation device or cap should be favoured to normal strip biopsy in the oesophagus because of the size of the resected specimen and its technical feasibility. A recently described method of EMR comprises the circumferential mucosal incision with a special type of needle-knife and subsequent en-bloc resection following prior injection under the lesions, but only a few patients with early Barrettʹs cancer were treated so far. EMR should be considered as the treatment of choice for high-grade intraepithelial neoplasia (HGIN) and mucosal adenocarcinoma in Barrettʹs oesophagus. First mid- and long-term results of endoscopic therapy show promising results, disease-free survival is comparable to oesophagectomy. Studies with larger patient numbers proved the efficacy and safety of ER, major complications occur <1%. Photodynamic therapy and other ablation therapies, although they are comparably effective, have a decisive disadvantage in comparison with ER: they lack the opportunity for histological processing of the resected specimen and therefore, provide no information regarding the depth of invasion of the individual layers of the oesophageal wall, and regarding radicality of the resection. Curative endoscopic treatment of early neoplastic lesions in Barrettʹs oesophagus should only be carried out in centers with a high-volume.