Endoscopic approach in the treatment of Barrett's esofagus. Resective and ablative tecniques.

Barrett's esophagus is a condition whereby the normal squamous epithelium is replaced by specialised or intestinalised columnar epithelium. The prevalence in the general population is 0.9 to 4.5% and there is a progression of 0.5%per year from Barrett's esophagus to adenocarcinoma. Proton pomp inhibitors are widespread as first line therapy for symptom controls for Barrett's esophagus patients. Non dysplasia (ND) and Low Grade Dysplasia Barrett’s esophagus are usually treated with periodical surveillance. The use of radiofrequencies ablation has been taken into account as conservative approach in non dysplastic or Low Grade Dysplastic (LGD) Barrett’s disease. Endoscopy, surgery and strict periodical surveillance has recommended for High Grade Dysplasia (HGD) Barrett's esophagus in order to avoid lead time bias and obtain early diagnosis of adenocarcinoma. Endoscopic treatment includes endoscopic mucosal resection (EMR) and ablation. More aggressive endoscopic interventions consisting of removing larger slices of esophageal mucosa or submucosal dissection have been described, but with long-term data uncertain, they remain somewhat controversial. Endoscopic mucosal resection (EMR) allows a 1.5-2 cm diameter piece of oesophageal mucosa to be removed. This provides better pathology for diagnosis and staging, and if the lesion is confined to the mucosa and fully excised, EMR can be curative. The combination of EMR and radiofrequency ablation has been used for multifocal lesions, but long-term outcomes are unknown. The new endoscopic interventions for Barrett's esophagus and early esophageal cancer have the potential to improve clinical outcomes, although evidence that confirms superiority over esophagectomy is limited. Latest recommendation from worldwide literature have been examined and reviewed about diagnosis and treatment of Barrett's esophagus.