Towards optimal endoscopic treatment for early esophageal neoplasia

Abstract

Treatment options for early stages of esophageal cancer have significantly improved over the last decades, with a radical shift in the treatment paradigm from surgery to endoscopic therapy. The aim of this thesis was to contribute to the optimization of endoscopic treatment for patients with premalignant stages and early forms of esophageal cancer. The first part describes some new insights into endoscopic treatment of Barrett esophagus, a precursor stage of esophageal cancer. Given the prophylactic nature of this treatment strategy, this thesis advocates for a careful balance between the benefits and risks of endoscopic treatment when determining the optimal end goal for each individual patient. Additionally, practical recommendations are made to improve the approach to specific, challenging patient groups and tissue sampling after successful treatment, which, under certain conditions, may be omitted. The second part explores an alternative ablation technique for the treatment of Barrett esophagus called cryoablation. In contrast to the current standard treatment, radiofrequency ablation, which uses heat, this new technique freezes tissue. The studies presented in this thesis demonstrate that cryoablation is a technically feasible, effective, and safe treatment method, with the key advantage of less pain after treatment. The third and final part focuses on personalized treatment strategies for patients with early esophageal cancer. In patients at high risk for lymph node metastases, a radical resection of the primary tumor followed by a sentinel lymph node procedure has proven to be feasible and safe. Using this minimally invasive alternative, it may be possible in the future to avoid a complete esophagectomy in carefully selected patients.