Endoscopic therapy in Barrett's esophagus: when and how?

Endoscopic ablative therapy, and endoscopic mucosal resection (EMR) are the two general types of endoscopic therapies available for the treatment of Barrett's esophagus. The ablative therapies destroy metaplastic tissue, but do not provide a pathology specimen by which to judge the completeness of the ablation. In contrast, EMR provides large tissue specimens that can be examined by the pathologist to determine the character and extent of the mucosal abnormality and, for neoplastic lesions, the depth of involvement and the adequacy of resection. In this article, we discuss the use of endoscopic therapies for Barrett's esophagus presenting with no neoplasia, low and high-grade dysplasia, and early adenocarcinoma.