Endoscopic Ablation Therapy: Imaging and Advanced Technology in Action

More than any other area of gastrointestinal endoscopy, ablation therapy has incorporated numerous imaging and technology advances to produce clinically important results for the treatment of Barrett's esophagus (BE) and superficial esophageal cancer to prevent the development of invasive malignancy (endoprevention).1 Focal ablation methods that use thermal energy have been available for many years. Devices such as thermal lasers, multipolar electrocoagulation, heater probe, and argon plasma coagulation have been used to treat BE since the mid 1980s.2 The important work by Sampliner and others established the proof of principal that Barrett's glandular mucosa ablation was technically feasible and that gastric acid suppression was important to successful mucosal remodeling to squamous epithelium.3 However, limitations of these “point-and-shoot”–type focal devices with variable tissue effects included areas of overtreatment (with risk of stricture and perforation) and undertreatment (with the risk of persistent subsquamous disease and subsequent development of carcinoma).