Optimizing endoscopic therapy for early Barrett’s neoplasia

Patients with a Barrett’s esophagus (BE) have an increased risk for the development of esophageal adenocarcinoma (EAC). When EAC is detected in an early stage, endoscopic treatment may be suitable, precluding these patients from invasive surgery. Yet, endoscopic treatment is only curative if the risk for lymph node metastases lies below the mortality risk of esophagectomy. This thesis shows that in a subgroup of patients with early EAC endoscopic treatment may be justified. Furthermore, this thesis describes a new treatment algorithm for patients who do need to undergo surgery, including radical endoscopic resection of the esophageal tumor followed by thoracolaparoscopic lymphadenectomy without concomitant esophagectomy. A preclinical study shows that lymphadenectomy without esophagectomy is feasible and safe on the short-term. Another study concluded that sentinel node navigation surgery may be a valuable tool limiting the extent of lymphadenectomy in early EAC patients.
The second part of the thesis concentrated on the treatment of flat BE, preventing the occurrence of EAC. Radiofrequency ablation (RFA) is highly effective in eradicating flat BE. In this thesis we evaluated if the ablation regimen for focal RFA treatment could be simplified without affecting efficacy or safety. Results show that a simplified ablation regimen, omitting the cleaning step, is non-inferior to the standard regimen in terms of efficacy. Cryoablation, an evolving ablation technique, might be an alternative to RFA. This thesis shows that cryoablation during 10 seconds of small BE areas is highly effective in the eradication of small, flat BE areas.