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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 4/2016

01-04-2016 | Review Article

Emerging Concepts for the Endoscopic Management of Superficial Esophageal Adenocarcinoma

Authors: Christina L. Greene, Stephanie G. Worrell, Stephen E. Attwood, Parakrama Chandrasoma, Kenneth Chang, Tom R. DeMeester, Reginald V. Lord, Elizabeth Montgomery, Oliver Pech, John Vallone, Michael Vieth, Kenneth K. Wang, Steven R. DeMeester

Published in: Journal of Gastrointestinal Surgery | Issue 4/2016

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Abstract

Introduction

Endoscopic therapy has revolutionized the treatment of Barrett’s esophagus with high-grade dysplasia (HGD) or intramucosal adenocarcinoma by allowing preservation of the esophagus in many patients who would previously have had an esophagectomy. This paradigm shift initially occurred at high-volume centers in North America and Europe but now is becoming mainstream therapy. There is a lack of uniform guidelines and algorithms for the management of these patients. Our aim was to review important concepts and pitfalls in the endoscopic management of superficial esophageal adenocarcinoma.

Methods

A small group colloquium consisting of gastroenterologists, surgeons, and pathologists reviewed published data and discussed personal and institutional experiences with endotherapy for HGD and superficial esophageal adenocarcinoma.

Results

The group reviewed data and provided recommendations and management algorithms for seven areas pertaining to endoscopic therapy for Barrett’s HGD and superficial adenocarcinoma: (1) patient selection and evaluation; (2) imaging and biopsy techniques; (3) devices; (4) indications for resection versus ablation; (5) ER specimen handling, processing, and pathologic evaluation; (6) patient care and follow-up after endoscopic therapy; and (7) complications of endoscopic therapy and treatment options.

Conclusions

Endoscopic therapy is preferred over esophagectomy for most patients with HGD or intramucosal adenocarcinoma, and may be applicable to select patients with submucosal tumors. Clear guidelines and management algorithms will aid physicians and centers embarking on endoscopic therapy and enable a standardized approach to the management of these patients that is applicable internationally.
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Metadata
Title
Emerging Concepts for the Endoscopic Management of Superficial Esophageal Adenocarcinoma
Authors
Christina L. Greene
Stephanie G. Worrell
Stephen E. Attwood
Parakrama Chandrasoma
Kenneth Chang
Tom R. DeMeester
Reginald V. Lord
Elizabeth Montgomery
Oliver Pech
John Vallone
Michael Vieth
Kenneth K. Wang
Steven R. DeMeester
Publication date
01-04-2016
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 4/2016
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-015-3056-0

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