Endoscopic assessment and management of early esophageal adenocarcinoma.

[esophageal adenocarcinoma]

Esophageal carcinoma affects more than 450000 people worldwide and the incidence is rapidly increasing . In the United States and Europe , esophageal adenocarcinoma has superseded esophageal squamous cell carcinoma in its incidence . Esophageal cancer has a high mortality rates secondary to the late presentation of most patients at advanced stages . Endoscopic screening is recommended for patients with multiple risk factors for cancer in Barrett 's esophagus . These risk factors include chronic gastroesophageal reflux disease , hiatal hernia , advanced age , male sex , white race , cigarette smoking , and obesity . The annual risk of esophageal cancer is approximately 0 .25 % for patients without dysplasia and 6 % for patients with high -grade dysplasia . Twenty percent of all esophageal adenocarcinoma in the United States is early stage with disease confined to the mucosa or submucosa . The significant morbidity and mortality of esophagectomy make endoscopic treatment an attractive option . The American Gastroenterological Association recommends endoscopic eradication therapy for patients with high -grade dysplasia . Endoscopic modalities for treatment of early esophageal adenocarcinoma include endoscopic resection techniques and endoscopic ablative techniques such as radiofrequency ablation , photodynamic therapy and cryoablation . Endoscopic therapy should be precluded to patients with no evidence of lymphovascular invasion . Local tumor recurrence is low after endoscopic therapy and is predicted by poor differentiation of tumor , positive lymph node and submucosal invasion . Surgical resection should be offered to patients with deep submucosal invasion .