Barrett's Esophagus with Low-Grade Dysplasia: When Endoscopic Eradication Therapy Has Not Achieved Complete Eradication
This protocol applies to patients with Barrett's esophagus and confirmed esophageal low-grade dysplasia who have undergone a full course of endoscopic eradication therapy without reaching the required eradication endpoints.
Clinical Scenario
Barrett's esophagus with confirmed esophageal low-grade dysplasia — a population in which endoscopic therapy is recommended to reduce the risk of progression to high-grade dysplasia or esophageal adenocarcinoma.
Previous Line — Failure Condition
The prior approach — endoscopic eradication therapy (EET) comprising endoscopic resection of visible lesions followed by radiofrequency ablation (RFA) of the remaining Barrett's epithelium, performed under maximal acid suppressive therapy — did not achieve the required endpoints of complete eradication of dysplasia (CED) and complete eradication of intestinal metaplasia (CEIM) within 18 months. This protocol addresses the next step after that failure.
Next-Step Approach
After failure to achieve complete eradication with radiofrequency ablation, an alternative endoscopic ablative modality may be considered. The complete structured protocol specifies the approach in full.
References
DOI: 10.14309/ajg.0000000000001680
We suggest endoscopic therapy in patients with BE with confirmed LGD to reduce the risk of progression to HGD/EAC, with endoscopic surveillance of confirmed LGD as an acceptable alternative (strength of recommendation: conditional; quality of evidence: moderate).
Endoscopic cryotherapy may be considered as an alternative modality in patients unresponsive to RFA.
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