Optimization of endoscopic treatment for Barrett’s esophagus with early neoplasia

Endoscopic treatment is nowadays considered to be the standard of care for patients with early Barrett’s neoplasia (i.e. high-grade dysplasia or early cancer). The combination of endoscopic resection (ER) of visible lesions followed by radiofrequency ablation (RFA) of the residual Barrett’s tissue, has proven to be a highly effective and safe treatment approach. The aim of this thesis was to assess improvements in endoscopic treatment and to evaluate the long term effects of endoscopic therapy for the treatment of early Barrett’s neoplasia.
In part one of this thesis we studied two different multiband mucosectomy devices (MBM) for ER treatment of BE, our results show that MBM is a safe technique for the treatment of Barrett’s esophagus (BE), regardless which MBM device is used.
Part two of this thesis focusses on RFA. Our long term follow-up results shows that successful RFA of early Barrett’s neoplasia results in a low risk of clinically relevant recurrences on the long term.
We evaluated the new Barrx™ 360 Express RFA balloon catheter (360 Express) which has recently replaced the traditional Barrx360 system. The standard ablation regimen, consisting of two ablations at 10J/cm2 with a cleaning step in between, offers the best balance between efficacy and safety when using the 360 Express for circumferential RFA and is therefore the recommended ablation regimen. For the 360 Express, a simplified ablation regimen consisting of 2 ablations without cleaning, should not be used given the associated high risk of severe stenosis.
In addition, we evaluated an endoscopic treatment strategy for patients with submucosal esophageal adenocarcinoma (T1b EAC) who underwent radical ER of T1bN0M0 EAC. We found that the risk of lymph node metastasis in this patient category appears to be lower than previously assumed. We concluded that an endoscopic follow-up approach following radical endoscopic resection of T1bN0M0 may be a valid alternative to additional surgery in a subset of patients.