Esophageal neoplasia revisited: Risk stratification, treatment, and long-term outcomes

Barrett’s esophagus is a condition characterized by damage to the inner lining of the distal part of the esophagus by reflux disease. This results in a change of the mucosa (“intestinal metaplasia”). This change results in an increased risk for development of esophageal adenocarcinoma (EAC). When symptomatic, the prognosis of EAC is limited due to advanced disease stages. Moreover, major surgery and/or chemotherapy are required, both of which have significant risk for complications. Therefore, patients with Barrett’s esophagus frequently undergo surveillance endoscopies with the aim to detect cancer at early stages. Endoscopic therapy is enabled for neoplasia, and is less invasive treatment with a lower risk for complications. Endoscopic therapy is a two-step approach and consists of endoscopic resection (ER) of visible lesions, followed by radiofrequency ablation (RFA) of the remaining Barrett’s segment, to enable regeneration with normal epithelial lining.
In this thesis, we evaluated different aspects to improve management of esophageal neoplasia. In Part I, we evaluated indications for endoscopic therapy. In Part II, we report the long-term outcomes of the combination therapy of ER and RFA and we propose different methods to personalize endoscopic treatment. Part III evaluated different new tools for resection of ablation. Finally, part IV evaluates the use of ablation therapy in squamous cell neoplasia.