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As more patients undergo earlier endoscopic evaluation for acid reflux symptoms, the identification of Barrett’s esophagus has been on the rise. The major concern, however, is the detection of dysplasia and the subsequent risk of progression to esophageal adenocarcinoma. Most cases of adenocarcinoma today arise from dysplastic Barrett mucosa. The standard of care for several decades has been careful surveillance biopsies to detect dysplasia. Current guidelines recommend that low-grade dysplasia (LGD) should warrant repeat endoscopic surveillance at six months following high-dose proton-pump inhibitor (PPI) therapy. High-grade dysplasia (HGD) has a greater risk of cancer progression and often has concomitant early esophageal neoplasia. This requires definitive therapy which has traditionally included surgical resection. However, in recent years, several minimally-invasive therapies have been used to perform ablation of Barrett’s mucosa including endoscopic mucosal resection (EMR), radiofrequency ablation, and cryospray ablation. Traditional therapy such as EMR and surgical resection may have technical challenges and associated morbidity.
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