Comparing apples with apples and oranges: The role of radiofrequency ablation alone versus radiofrequency ablation plus EMR for endoscopic management of Barrett's esophagus with advanced neoplasia

摘要

There are 5 therapeutic maneuvers that can be performed with an endoscope. One can (1) remove tissue, (2) ablate tissue, (3) control bleeding, (4) unclog lumina, and (5) appose tissue. For example, I can (1) snare a polyp, (2) cauterize dysplastic Barrett's esophagus, (3) coagulate a bleeding visible vessel, (4) stent a stricture, and (5) clip a perforation. Of the 5 endoscopic therapies, only 2 are relevant for eliminating cancer or precancerous pathology: tissue removal and ablation. Tissue removal has the unique appeal that a specimen is available for analysis. So when a polyp is the target of attention, removing it rather than destroying it is usually the preferred strategy. But Barrett's presents a challenge that does not exist with a focal elevated target. It most commonly is found as a diffuse, circumferential, flat lesion lining a cylindrical tube. The topography of the disease does not usually lend itself to tissue resection. To eliminate Barrett's, it is generally necessary to ablate it.