What Is Cold and What Is Hot in Mucosal Ablation for Barrett's Oesophagus-Related Dysplasia: A Practical Guide

Over the last two decades, endoscopic eradication therapy has been established as the therapeutic strategy of choice for patients with Barrett's oesophagus-related dysplasia and early oesophageal adenocarcinoma. With a multimodal approach, ablative therapies have been highly effective in achieving remarkable eradication rates of metaplastic epithelium with an acceptable adverse event rate. Among ablative techniques, radiofrequency ablation is currently considered as the first-line option as its efficacy and safety are strongly supported by relevant data. Nevertheless, radiofrequency ablation is costly, and not universally available, or applicable to every situation. Moreover, primary failure and recurrence rates are not negligible. In the last few years, cryotherapy techniques and hybrid argon plasma coagulation have been increasingly assessed as potential novel ablative therapies. Preliminary data have been promising and suggest that they may even have a role as first-line options, alternatively to radiofrequency ablation. The aim of this review is to provide a practical guide for the ablation of Barrett's oesophagus, with emphasis on the different ablative options.

Automated summary

Over the last two decades, endoscopic eradication therapy has become the preferred treatment strategy for patients with Barrett's oesophagus-related dysplasia and early oesophageal adenocarcinoma. Radiofrequency ablation is the first-line option due to its proven effectiveness and safety, although it is expensive and not universally applicable. Cryotherapy techniques and hybrid argon plasma coagulation have shown promising results as potential alternatives to radiofrequency ablation. This review aims to provide a practical guide for the different ablative options for Barrett's oesophagus.