Editing Barrett's oesophagus (section)

== '''Endoscopic therapy''' ==

* Goals are removal of BE     epithelium, while preserving overall integrity of the oesophagus and     accurately staging dysplasia or invasive disease
* Should have close     surveillance and PPI afterwards
* Beware the risk of 'buried     glands' - areas of Barrett's epithelium hidden beneath areas of new     squamous epithelium, even if the risk of malignancy in those glands     appears to be low
* '''Radiofrequency     ablation'''
** Most commonly used      endoscopic therapy
** This is the HALO device,      although I think it has been renamed now to 'Barrx'
** Much more effective than      photodynamic therapy with a lower stricture and overall complication rate
** Delivered with either a      circumferential balloon or an electrical plate. The treated mucosa is      replaced by neosquamous mucosa. The standard ablation program uses two      double pulses of 12 J/sq cm.
** AIM-II trial - 81% of      patients with HGD and 90% of patients with LGD had eradication of      dysplasia. 4% had their dysplasia progress to a higher grade.
* '''Argon plasma     coagulation'''
* '''Cryotherapy'''
** Generally well tolerated      with little pain and low stricture rates
** Does not require the probe      to be in contact with tissue
** Use either a balloon or      endoscopic spray catheter to deliver liquid nitrogen
** Eradicated LGD and HGD at      91% and 81% respectively in one study
** Can be used as salvage      therapy after failed RFA
* '''Photodynamic     therapy'''
* '''Endoscopic     mucosal resection'''
** Best for visible segments
** Commonly use 'Duette' system      (Cook)
* '''Endoscopic     submucosal dissection'''
** Better with >2cm
** Best option for cancer
* '''Surveillance     after eradication'''
** Previous HGD: 1, 2, 3, 4, 5,      7, 10 years after treatment
** Previous LGD: 1, 3, and 5      years after treatment

[[Category:UGIS]]