Endoscopic Treatment of Early Esophageal Neoplasia

Esophageal cancer is among the most common cancers worldwide, and the prognosis remains dismal. However, when esophageal cancer is encountered early, survival can be dramatically improved with therapy. Until recently, the only curative treatment option was esophagectomy, which carries substantial risk and may not be advised in patients with significant comorbidities. Improvements in endoscopic resection techniques devised to procure larger amounts of tissue for accurate staging, namely endoscopic mucosal resection and endoscopic submucosal dissection, have also enabled endoscopists to curatively treat early esophageal cancers. Moreover, residual mucosa that could become neoplastic is treated with ablative therapies that can be applied with less morbidity than previously. Endoscopic methods to treat cancer have become an important tool for the gastroenterologist, and their mechanisms, techniques, and evidence are reviewed in this chapter.