Advances in approach and therapy for early esophageal neoplasia

The incidence of esophageal cancer is rising in the western world, mostly adenocarcinomas that may arise from pre-malignant Barrett’s mucosa. In Asia/Africa squamous cell carcinomas are more frequently found. Recent improvement of imaging and treatment techniques allows endoscopic treatment of early neoplasia. Visible lesions may be endoscopically resected, followed by ablation of remaining mucosa (in case of Barrett’s esophagus) to prevent development of metachronous lesions. This thesis describes novel insights in work-up, decision making and treatment for this early esophageal neoplasia. First, it emphasizes the value of centralization of work-up and treatment for Barrett’s neoplasia in expert centers. Moreover this thesis describes the (limited) advantages of endoscopic tools for certain endoscopic resection techniques. Third, pre-clinical and early clinical data show that a novel ablation technique (cryoablation) may be feasible and efficient for treatment of Barrett’s esophagus. In turn, radiofrequency ablation (which is currently the ablation technique of choice) appears less suitable for ablation of early squamous cell neoplasia. Finally, this thesis confirms the trend that endoscopic therapy (rather than surgery) is justified in a carefully selected group of adenocarcinomas.