Barrett's Esophagus with High-Grade Dysplasia When Endoscopic Eradication Therapy Has Not Achieved Complete Eradication

This protocol applies to patients with Barrett's esophagus confirmed with high-grade dysplasia (HGD) or intramucosal carcinoma (IMC) who have undergone a full course of endoscopic eradication therapy but did not meet the required eradication endpoints within the expected timeframe.

Clinical Scenario

Barrett's esophagus with confirmed esophageal high-grade dysplasia or esophageal intramucosal carcinoma. In this population, endoscopic eradication therapy is strongly preferred over esophagectomy.

Prior Line & Failure Condition

          The preceding treatment line was endoscopic eradication therapy (EET) — comprising endoscopic resection of any visible lesions within the Barrett's segment followed by ablative therapy with radiofrequency ablation (RFA), performed under maximal acid suppressive therapy. The defined treatment goals were complete eradication of dysplasia (CED) and complete eradication of intestinal metaplasia (CEIM) within 18 months. This protocol is indicated when those endpoints were not achieved.
        

Next-Step Approach

An alternative ablative modality is available for patients who have not responded adequately to the prior approach. Full selection criteria, procedural context, and the complete structured regimen are available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.14309/ajg.0000000000001680

We recommend EET compared with esophagectomy in patients with BE with HGD or IMC (strength of recommendation: strong; quality of evidence: moderate).

Endoscopic cryotherapy may be considered as an alternative modality in patients unresponsive to RFA.

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