Gut Check on Gastroenterology Archive

The first cases of Barrett esophagus (BE) ablation in the late 1980s used YAG and Argon laser. Since then, a myriad of ablation techniques have been described, including multipolar electrocautery (MPEC), argon plasma coagulation (APC), cryotherapy, radiofrequency ablation (RFA), and endoscopic mucosal resection (EMR). Each technique has had its advocates, and some of the techniques appear to have certain advantages in certain types of BE: e.g., long segment, nodular, etc.

Most cases of BE are short segment, and most neoplastic cases do not have nodules or erosions. So the question I would like to see discussed is: In a patient with 1–2 cm of otherwise featureless flat but neoplastic BE:

What ablation technique would you use, and what do you feel makes this technique advantageous?

What would be your second option, and when would you employ it?

Do you use more than one technique, and, if so, which ones do you use and why?

What are the most common complications you see with BE ablation?

What is your overall success at complete BE elimination?

We look forward to your comments.