Endoluminal treatment of Barrett's esophagus: Current and future prospects

Endoluminal treatment of Barrett's esophagus has become the preferred option for initial intervention for advanced neoplasia without invasive carcinoma. Data from abstracts presented at Digestive Disease Week 2008 provide greater insight into optimal use of existing techniques and an early look at potential next generation therapies. Results from the AIM Dysplasia trial describe a larger study with longer post-treatment surveillance highlighting the efficacy and tolerability of radiofrequency ablation, while early results from liquid nitrogen cryotherapy studies suggest a potential to obtain similar eradication results with very high tolerability. Endoscopic resection, despite its risks, remains a popular option for focal as well as more widespread resection of Barrett's mucosa. Additional abstracts highlight novel approaches to ablation and resection. Enhanced imaging techniques and molecular marker analysis also appear to improve treatment outcomes. However, time and further studies of combined approaches to diagnosis and eradication are necessary to optimize treatment algorithms.