Stepwise radical endoscopic resection versus radiofrequency ablation for Barrett's associated dysplasia and early cancer

Stepwise radical endoscopic resection (SRER) is safe and effective for early Barrett's neoplasia, but is associated with oesophageal stenosis. Focal endoscopic resection (ER) followed by radiofrequency ablation (RFA) is safe and effective for early Barrett's neoplasia, but does not yield a complete specimen for histological evaluation. In this issue of Gut, van Vilsteren et al compared the safety of SRER versus focal ER followed by RFA for complete eradication of Barrett's oesophagus (BO) containing high grade dysplasia/early cancer. They conducted a multicentre clinical trial and randomised patients with BO <5 cm containing high grade dysplasia/early cancer to SRER or ER/RFA. Patients in the SRER group underwent piecemeal ER of 50% of BO followed by serial ER. Patients in the ER/RFA group underwent focal ER for visible lesions followed by serial RFA. Follow-up endoscopy was performed at 6 and 12 months and then annually. The main outcome measures were: stenosis rate; complications; complete histological response for neoplasia (CR-neoplasia); and complete histological response for intestinal metaplasia (CR-IM). SRER resulted in a higher rate of oesophageal stenosis and required a higher total number of therapeutic sessions due to dilation sessions for oesophageal stenoses. The authors concluded that for patients with early Barrett's neoplasia a combined endoscopic approach of focal ER followed by RFA may be preferred over SRER (see page 765).