Endoscopic treatments for early gastroesophageal lesions

Abstract

Gastroesophageal (GEJ) carcinoma is well-recognized since the 1970s and has shown 2.5-fold increase in incidence since then. There still exists much controversy and ambiguity in the literature about the occurrence and recurrence of these lesions post-treatment. This has been attributed to the variability in the terms and definitions used in these junctional lesions. Despite this, great strides have been made in the treatment of early lesions decreasing morbidity and mortality from surgical treatment options. The current modalities involve ablation [like radiofrequency, cryo or argon plasma coagulation (APC)] and/or resection [endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD)] depending on the type and nature of lesion. These techniques are an effective tool demonstrating high rates of complete eradication of metaplasia or dysplasia (CE-IM/CE-D). It is crucial that the endoscopists are mindful about meticulous examination of the GEJ and Cardia as well as partake in appropriate surveillance post-endoscopic eradication. In addition, appropriate documentation of the location and type of lesion is also extremely important. This review aims to compare current endoscopic techniques in their efficacy, need for expertise and risk of complications when used in the treatment of early junctional lesions. Future studies and guideline recommendations to standardize definitions, diagnoses and post-treatment surveillance are needed.