Barrett's esophagus: new screening methods and new endoscopic therapy

New endoscopic techniques allow, for the diagnosis, to better identify dysplastic lesions using "virtual" chromoendoscopy (without replacing systematic biopsies), and for the treatment, to resect large superficial lesions or ablate the entire Barrett's mucosa (the latter technique uses radiofrequency and does not provide any specimen). Endoscopic resection allows (1) to more accurately stage the lesion than biopsies, (2) to be curative in case of high grade dysplasia or intramucosal carcinoma. Radiofrequency ablation of the entire metaplastic mucosa is recommended after resection of neoplastic lesions with a curative intent (to avoid recurrences) or as first line treatment in case of dysplasia without visible lesion. In practical, if neoplasia is detected during screening endoscopy, a careful (chromoendoscopy) examination is required to orient patient's management (resection and/or radiofrequency ablation).