Endoscopic submucosal dissection in endotherapy for Barrett’s esophagus–related dysplasia and neoplasia: An essential or optional technique?

Endotherapy for dysplasia or neoplasia arising in Barrett's esophagus (BE) is now established as the standard of care, being recommended by several gastroenterology society guidelines.1,2 The cornerstones of this strategy are as follows: (1) endoscopic resection to remove visible lesions, which serves to provide accurate histologic staging (distinguishing dysplasia and mucosal adenocarcinoma [EAC] from submucosal adenocarcinoma) and prognostic information (such as grade of differentiation and lymphovascular invasion); followed by (2) ablation by the use of thermal therapy or cryogens to destroy the metaplastic epithelium, which when accompanied by acid suppression ensures squamous re-epithelialization.

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