Table 1.

Technique	Study	Study Design	Dysplasia grade included (sample size)	Outcomes	Advantages	Limitations
Endoscopic resection techniques
Focal Endoscopic resection	Pech et al$ 113	Single center cohort	HGD (61) IMCA (288) Median follow up 63months	CR–D: 97% Recurrence of HGD/IMCa: 21.5% Overall 5 year survival : 84%	Allows precise determination of depth of invasion and assessment of margins Less variability in pathological assessment	May need multiple sessions to achieve remission Focal EMR alone may be associated with higher recurrence rates and positive margins Bleeding (0.6% to 6%) Perforation (0% to Stricture (4%)
	Prasad et al # 114	Single center cohort study (endoscopic : PDT/EMR and surgical cohorts)	IMCa (178) Median follow up Surg 64m Endo 43m	CR-D: 94% Recurrent Ca : 12% Overall 5 year survival: 83% in the Endo group and 95% in Surg group
Circumferential endoscopic resection	Gondrie et al 162	Multicenter cohort study	HGD/IMCa (149) Median follow up 18months	CR-IM : 97% Recurrent neoplasia 3% 2-3 sessions needed to achieve CR	Low rate of recurrence by removing all at-risk mucosa With availability of EMRL easier to perform	Perforation 1% High stricture rate 52% Bleeding 1-4%% Ridges of tissue persist between EMR sites which may contribute to recurrence Buried metaplasia (8%)
	Larghi et al 123	Multicenter cohort study	HGD/IMCa (26) Median follow up 28months	CR-IM : 88% Recurrent neoplasia 4% (IMCa)
Submucosal Dissection	Yoshinaga et al 163	Single center cohort study	GE junction adenoCa (24) Median follow up 30m	CR : 72% No recurrence in those with CR	En bloc resection allows clear margins to be obtained May be more suitable in lesions > 2 cm in diameter	Long procedure times Strictures
Endoscopic ablation techniques
Thermal
Multipolar electrocoagulation	Sampliner et al 135	Multicenter cohort study	No dysplasia (58) Median follow up 6m	CR-IM : 78%	Technically easy Relatively inexpensive Well tolerated (1/58 developed stricture, 1/58 hospitalized for chest pain) Persistent reversal of IM at 24 m in 68%	Difficult to treat longer segments (study used 10F probe via therapeutic endoscope) Not used for treatment of HGD Short follow up
	Sharma at al 164	Multicenter randomized controlled trial (comparing MEPC and APC)	No dysplasia and LGD (35) Median follow up 24 m	CR-IM : 83% (75% MPEC, 63% with APC) CR-IM at 24 m : 68%
Argon Plasma Coagulation	Attwood et al 165	Single center cohort study	HGD (29) Median follow up 37m	CR-D :86% CR-IM: 76% 4 patients progressed to EAC 1 esophageal perforation	Technically easy to perform	Dosimetry variable across studies Superficial effect leads to high prevalence of buried metaplasia Perforation reported Limited evidence in HGD
	Ferraris et al 166	Multicenter cohort study	No dysplasia (96) Median follow up 36 m	CR-IM 96% Recurrence 18%
Radiofrequency Ablation	Shaheen et al 147	Multicenter, sham controlled RCT	HGD (64) LGD (63)	CR-IM (12 m): 77% vs. 2.3% CR-D (12m) HGD : 81% vs. 19% LGD: 90% vs. 23% Progression to Ca: 19% vs. 2%	Well tolerated by most patients Low stricture rate (6%) Low rate of subsquamous BE (5%)	Ablation requires multiple steps Long term data on durability of ablation and recurrence not available
	Fleischer et al 116	Multicenter, cohort study	No dysplasia (100)	CR-IM (12m) : 70% CR-IM (30m): 96%
Photochemical
Porfimer PDT	Overholt et al 115	Multicenter, partially blinded controlled RCT	HGD (208)	CR-HGD (24m): 77% Vs 38% CR-IM (24m) : 52% Vs 7% CR-D (24m): 59% Vs. 14%	Easy to administer Results of RCT durable at 5 years33	Photosensitivity (60%) Strictures (27-39%)5 Significant post procedure morbidity
	Prasad et al 141	Single center cohort study (endoscopic : PDT/EMR and surgical cohorts)	HGD (199)	Overall survival comparable at 5 years between endoscopic and surgical cohorts. No death from esophageal carcinoma in both groups	Compares favorably to esophagectomy36
ALA PDT	Pech et al 167	Single center cohort study	HGD (35) IMCA (31)	CR-D : 100% CR-D : 97% Median follow up 37m	Oral administration of 5-ALA Limited photosensitivity	Minor adverse effects 40% No strictures reported 29% recurrent carcinoma
	Peters et al 144	Single center cohort study	Residual HGD or IMCA after EMR (23)	CR-D : 75% CR-IM: 0% Median follow up 30m Recurrent HGD : 27%	Oral administration of 5-ALA	Major adverse effects : arrhythmia, hypotension, hematemesis Buried metaplasia in 33% High recurrence rate Death has been reported
Cryotherapy
Liquid N2 spray	Greenwald et al 150	Multicenter cohort study	IMCA, HGD, Non dysplastic BE, severe squamous dysplasia (77)	CR-D : 88% (in HGD) CR-IM: 53% 1 perforation (in patient with Marfan Syndrome) 3 esophageal strictures Adverse effects: chest pain (17%), dysphagia (13%)	No mucosal contact required Well tolerated by most patients	Dosimetry not well established No controlled data available Technically challenging : need for accompanying decompression tube, visibility impaired due to freezing
CO2 spray	Canto et al 151	Single center cohort study	HGD/IMCA (44) Median follow up 12m	CR-IM 86% (after median of 6 procedures)	Initial promising results in patients who failed other forms of ablation (n=25) including EMR	Additional decompression tube not needed. May be option for patients who fail RF ablation, PDT

RCT : randomized controlled trial

CR-IM : complete remission – intestinal metaplasia

CR-D : complete remission – dysplasia

IMCA : intramucosal carcinoma

^$: Additional ablative therapy used : PDT used in 64 patients, APC in 136 patients

^#: Additional ablative therapy used : PDT used in 43 patients