Endoscopic therapy for Barrett’s esophagus: a narrative review of potential complications and their management

Abstract

: Barrett’s esophagus (BE) is a well-known risk factor for the development of esophageal adenocarcinoma (EAC). This histologic transformation occurs in a stepwise fashion with progression from intestinal metaplasia (IM) to low-grade dysplasia (LGD), high-grade dysplasia (HGD), intramucosal adenocarcinoma (IMCA), and ultimately invasive EAC. Standardized guidelines have been developed for screening, surveillance and treatment of dysplastic/neoplastic BE. Endoscopic eradication therapy (EET) is recommended over esophagectomy for dysplasia and early (mucosal) neoplasia based on its efficacy and favorable risk profile. EET consists of endoscopic resection of any nodular lesions followed by endoscopic ablation of Barrett’s mucosa. Endoscopic resection can be performed by endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). There are several effective modalities available for endoscopic ablation including radiofrequency ablation (RFA), cryoablation, argon plasma coagulation (APC), and/ or hybrid-APC. Often times, multimodal endoscopic therapy is utilized with a combination of endoscopic resection and ablation techniques. While generally well tolerated, complications from these therapeutic procedures do occur, including sedation-related events, post-procedure chest pain, luminal perforation, bleeding and esophageal stricture. Complications may occur intraprocedure, immediately post-procedure, or delayed post-procedure. Treatment depends upon the severity of the complication, hemodynamic stability of the patient, and timing of presentation. This review highlights the potential complications associated with BE endotherapy and the management thereof.