Life (Apr 2023)

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

  • Marco Spadaccini,
  • Ludovico Alfarone,
  • Viveksandeep Thoguluva Chandrasekar,
  • Roberta Maselli,
  • Antonio Capogreco,
  • Gianluca Franchellucci,
  • Davide Massimi,
  • Alessandro Fugazza,
  • Matteo Colombo,
  • Silvia Carrara,
  • Antonio Facciorusso,
  • Pradeep Bhandari,
  • Prateek Sharma,
  • Cesare Hassan,
  • Alessandro Repici

DOI
https://doi.org/10.3390/life13041023
Journal volume & issue
Vol. 13, no. 4
p. 1023

Abstract

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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.

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