Mucosal ablation therapy of Barrett esophagus

Barrett esophagus is defined by the metaplasia of existing squamous mucosa into a specialized intestinal-type mucosa, The importance of this metaplasi a is the association of this condition with the development of adenocarcino ma of the esophagus, Elimination of the metaplastic mucosa may decrease the cancer risk. Currently, several forms of therapy have evolved with the goa l of replacing the specialized mucosa with normal squamous mucosa, These pr oposed treatments include photodynamic therapy and thermal techniques. The effectiveness of photodynamic therapy varies depending on the pharmaceutica l photosensitizer used and the wavelength of light applied to activate the drug. Thermal techniques include multipolar coagulation, argon plasma coagu lation, KTP:YAG laser therapy, Nd:YAG laser therapy, and argon laser therap y. Finally, mucosal resection has been attempted through the endoscope to r emove large areas of the Barrett mucosa, All of these ablative strategies a ttempt to destroy the metaplastic mucosa and promote the regrowth of squamo us epithelium. These therapies have demonstrated the ability to "reverse" t he metaplasia to varying degrees, but a decrease in cancer risk has not bee n demonstrated conclusively with any of these treatment methods.