Barrett’s esophagus in 2016: From pathophysiology to treatment

Table 2 Recommendations for endoscopic eradication therapy in Barrett’s esophagus

Guidelines	NDBE	LGD	HGD/intramucosal EAC
ACG[118]	Not recommended	Not recommended	Endoscopic ablation or surgical esophagectomy
AGA[59]	RFA (± EMR) for select individuals at risk for progression	RFA is a therapeutic option	Endoscopic therapy with RFA, PDT or EMR EMR in BE dysplasia with a visible mucosal irregularity Before proceeding with esophagectomy, patients with HGD or intramucosal EAC should be referred for evaluation by surgical specialized centres
BAD CAT[120]	-	-	Endoscopic treatment should be preferred over endoscopic surveillance or surgery for the management of most patients with HGD/intramucosal EAC RFA is currently the best available ablation technique for the treatment of flat HGD and for the eradication of residual BE after focal EMR In the HGD endoscopic resection of all visible abnormalities, cap and snare and band ligation with resection are equally effective
ASGE (2012)[100]	Consider endoscopic ablation in select cases	Consider endoscopic resection or ablation	Consider endoscopic resection or RFA ablation. Consider EUS for local staging and lymphadenopathy Consider surgical consultation
BSG[58]	Not recommended	Not routinely recommended	Endoscopic therapy preferred over esophagectomy
ASGE (2013)[123]	-	-	EMR is indicated for nodular BE and T1a EAC and may be used for flat BE with HGD ESD can be used in similar situations but is preferred to EMR for large areas of dysplasia or T1b EAC (i.e., confined to the submucosa) Ablation techniques may be used alone or in combination with mucosal resection techniques
BOB CAT[90]	If the lesion is visible, endoscopic resection for diagnosis is then appropriate ablative therapy		-
	Not recommended	Lower risk: Intense surveillance. Higher risk: Ablative therapy with follow-up

ACG: American College of Gastroenterology; AGA: American Gastroenterology Association; BAD CAT: Barrett’s Dysplasia and Cancer Taskforce; ASGE: American Society for Gastrointestinal Endoscopy; BSG: British Society for Gastroenterology; BOB CAT: Benign Barrett’s and Cancer Taskforce; RFA: Radiofrequency ablation; EMR: Endoscopic mucosal resection; PDT: Photodynamic therapy; EUS: Endoscopic ultrasound; ESD: Endoscopic submucosal dissection; BE: Barrett’s esophagus; NDBE: Non-dysplastic Barrett’s esophagus; LGD: Low-grade dysplasia; HGD: High-grade dysplasia; EAC: Esophageal adenocarcinoma.