Detection and endoscopic therapy of early esophageal adenocarcinoma.

PURPOSE OF REVIEW: This review summarizes recent progress on endoscopic diagnosis and treatment of esophageal high-grade intraepithelial neoplasia and early adenocarcinoma and critically analyzes the literature in the context of preexisting scientific data.

RECENT FINDINGS: Narrow band imaging and computed virtual chromoendoscopy enhanced visualization of the mucosal morphology. The type of mucosal and capillary patterns seen on narrow band imaging predicted the presence of specialized intestinal metaplasia, high-grade intraepithelial neoplasia and early adenocarcinoma. Endocytoscopy lacked sufficient image quality for clinical use currently. Optical coherence tomography had the potential to diagnose specialized intestinal metaplasia and dysplasia. Photodynamic therapy produced long-term ablation of high-grade intraepithelial neoplasia and reduced cancer risk. Endoscopic radiofrequency ablation of Barrett's mucosa did not cause strictures and buried glandular mucosa. Localized and radical or complete circumferential endoscopic mucosal resections were effective and safe.

SUMMARY: Virtual chromoendoscopy detected subtle mucosal lesions and facilitated targeted biopsies. Photodynamic therapy was effective in the long term. Endoscopic radiofrequency ablation appeared promising. Localized and radical or complete circumferential endoscopic mucosa resections were effective therapies.