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The SAGES Manual pp 273–284Cite as

18. Endoscopic Ablative Therapy

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Abstract

Barrett’s esophagus (BE) results from repeated damage of the esophageal squamous epithelium from gastroesophageal reflux. The defining lesion of BE is specialized intestinal epithelium which is characterized by columnar metaplastic epithelium with goblet cells. BE is a premalignant lesion that progresses to adenocarcinoma at a rate of 0.5% per year. This risk of progression increases with increasing degrees of dysplasia. High-grade dysplasia (HGD) carries the highest risk of developing esophageal adenocarcinoma (EAC) that is 60–125 times that of nondysplastic BE.

The current standard of care for BE with nonvisible HGD is endoscopic ablation. Radiofrequency ablation (RFA) has been found to be safe and effective for the treatment of HGD and can be used in combination with endoscopic mucosal resection for the treatment of superficial (Tis or intramucosal carcinoma and T1a or tumor invade the lamina propria or muscularis mucosae but does not invade the submucosa) EAC. In these clinical settings, the risk of lymph node involvement is low (<4%); thus, localized therapy is effective and can spare patients the morbidity (30%) and mortality (1–2%) of an esophagectomy.

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Authors and Affiliations

  1. Department of Surgery, Oregon Health & Science University, Portland, OR, USA

    Erin W. Gilbert M.D.

  2. Department of Surgery, Oregon Health and Sciences University, Portland, OR, USA

    John G. Hunter M.D.

Authors
  1. Erin W. Gilbert M.D.
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  2. John G. Hunter M.D.
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Corresponding author

Correspondence to Erin W. Gilbert M.D. .

Editor information

Editors and Affiliations

  1. Medical Center, Department of Surgery, University of California, Irvine, Orange, 92868, California, USA

    Ninh T. Nguyen

  2. Clinics, Department of Surgery, University of Iowa Hospitals and, Iowa City, 52242, Iowa, USA

    Carol E.H. Scott-Conner

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© 2012 Springer Science+Business Media, LLC

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Gilbert, E.W., Hunter, J.G. (2012). 18. Endoscopic Ablative Therapy. In: Nguyen, N., Scott-Conner, C. (eds) The SAGES Manual. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-2347-8_18

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  • DOI: https://doi.org/10.1007/978-1-4614-2347-8_18

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-2346-1

  • Online ISBN: 978-1-4614-2347-8

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