Endoscopic diagnosis and treatment of esophageal adenocarcinoma

The incidence of esophageal adenocarcinoma is rising worldwide. Barrett's esophagus (BE) is the major risk factor. Diagnostic criteria are histopathological diagnosis of intestinal metaplasia with goblet cells and a minimal length of 1 cm. Gastroscopy with high-definition video quality and (virtual) chromo-endoscopy is recommended. Artificial intelligence for detection, characterization, and indicating biopsy site of suspicious lesions is currently being intensively evaluated and will hopefully be broadly available soon. Treatment of Barrett's associated lesions is dependent on histology. For BE without dysplasia, endoscopic surveillance is recommended. BE with low-grade dysplasia can either be ablated (radiofrequency ablation [RFA]/argon plasma coagulation [APC]) or followed with endoscopic surveillance. Visible lesions representing high-grade dysplasia or early cancer should be treated with endoscopic resection (endoscopic mucosal resection [EMR]/endoscopic submucosal dissection [ESD]) followed by thermal ablation (RFA/APC) of the residual BE. This treatment is recommended for low-risk T1b adenocarcinomas (sm1 < 500ym, L0, V0, G1/G2, VM0-R0, where sm1: submucosal invasion limited to the mucosa or submucosa, L0: no lymphatic invasion, V0: no venous invasion, VM: vertical margin).