Radiofrequency ablation for Barrett's dysplasia: past, present and the future?

Barrett's oesophagus is the only know pre-cursor to oesophageal adenocarcinoma. The incidence of OAC is growing rapidly in the western world with a poor prognosis for most with a 5-year survival of only 15%. The approach to treating patients with neoplasia arising within BE has dramatically changed in the past 5 years. Resection of visible lesions with endoscopic mucosal resection followed by field ablation with radio-frequency ablation is now the accepted standard of care in these patients worldwide. This combined approach has shown high rates of disease reversal in several high quality clinical trials but also large volume registry studies. As well as being a minimally invasive and oesophageal sparing interventions compared to surgery with oesophagectomy, endoscopic therapy has proved to be safe and emerging long-term data show sustained benefit in the majority of patients and low rates of cancer progression. However, in a sub-group of patients, recurrences have been reported after successful endoscopic therapy making it mandatory to follow these patients post therapy. Improvements in endoscopic imaging continue to aid early diagnosis, and in turn, this will allow clinicians the ability to offer patient's treatment at an early stage.