Endoscopic treatment of Barrett's neoplasia and gastric cancer Standards and new developments

Endoscopic therapy of Barrett's neoplasia and gastric cancer represents the current therapeutic standard in early stages of the disease. Endoscopic detection by high-resolution white light endoscopy with the aid of chromoendoscopy is crucial. Resectability is then assessed based on the mucosal surface pattern and vascular structure, as these allow prediction of malignancy and depth of invasion. Treatment of Barrett's neoplasia then follows a two-stage concept. In the first step, complete endoscopic resection by endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for larger lesions is performed. Endoscopic resection is used as both a diagnostic (histology, staging with depth extension) and therapeutic procedure. After curative endoscopic resection of a Barrett's neoplasm, radiofrequency ablation (RFA) of the remaining nonneoplastic Barrett's mucosa is then indicated as a second step to prevent metachronous neoplasia. Subsequently, endoscopic surveillance is required. For the treatment of early gastric cancer, ESD is the procedure of choice based on the guideline due to higher R0 and en bloc resection rates compared to EMR. After curative endoscopic resection, unlike after surgical therapy with gastrectomy, structured endoscopic follow-up is required due to a significant risk of metachronous gastric cancer.