Novel endoscopic therapies in Barrett’s esophagus: narrative review

: In the last decade, the management of Barrett’s esophagus (BE) has been broadly updated. Among the endoscopic ablative techniques, radiofrequency ablation (RFA) is highly effective and currently represents the standard of care for the eradication of BE after endoscopic resection of visible dysplastic lesions. Newly, some thermal and non-thermal endoscopic modalities have been investigated for treating BE, also as first-line in case of dysplasia. Data on the safety and efficacy of cryotherapy, hybrid argon plasma coagulation (APC) and EndoRotor resection have been recently reported in the literature. We aimed to review current evidence on novel endoscopic technologies emerging with the indication of treating BE, and to discuss their limitations, advantages and potential implementation in routine clinical practice as well as in clinical trials. A PubMed search was conducted up to August 2020 to identify relevant studies. Efficacy rates, in terms of dysplasia and metaplasia eradication, assessed for the emerging thermal and non-thermal endoscopic modalities are promising and similar to RFA. According to the present data, post-treatment stricture occurrence appears to be low especially after Hybrid-APC and EndoRotor. The current evidence on novel endoscopic techniques needs further endorsement by randomized clinical trials and meta-analysis. The comparison of these modalities to the traditional care by the ongoing clinical trials, particularly in naïve patients is highly warranted. 10 dysplasia, and survival in EAC is stage-dependent. Patients with non-dysplastic (ND) BE or low-grade dysplasia (LGD)