Endoscopic therapy for Barrett’s: highly effective, but not perfect

“It used to be esophagectomy for all,” Dr. Sharma said. “Now the paradigm has switched, and it is endoscopic therapy for all.”

That paradigm shift is supported in part by a German study showing excellent long-term results in 1,000 consecutive patients receiving endoscopic treatment of mucosal adenocarcinoma of the esophagus.

In that study, nearly all of the patients (963, or 96.3%) had a complete response, with 12 patients undergoing surgery because of failure of endoscopic therapy. Fifteen patients (1.5%) had major complications that were nonetheless managed conservatively, according to investigators. Although new lesions or recurrences were seen in 140 patients (14.5%) over 5 years of follow-up, 115 patients had successful endoscopic retreatment. Based on these data, the investigators calculated a 10-year survival rate of 75%.

On the basis of these findings, investigators said endoscopic therapy should be considered the standard of care for patients with mucosal adenocarcinoma of the esophagus.