Objective:New endoscopic techniques allow diagnosis, staging and therapy of benign and malignant esophageal lesions. The aim of this study was to review our experience with endoscopic therapy (ET) in the esophagus.Methods:Retrospective review of the records of all patients who had endoscopic resection (ER) and/or ablation in the esophagus or gastroesophageal junction.Results:In 71 patients (56M/15F) with a median age of 64 years (IQR 56-74) 171 endoscopic procedures (112 ER, 59 ablations) were performed (median of 2 procedures per patient). ER was performed in 54 patients with a visible lesion. In 26 of these patients the ER was done as a staging procedure prior to an esophagectomy. In 7 patients a benign lesion was diagnosed and required no further intervention. In 21 patients either high-grade dysplasia (HGD) or intramucosal cancer (IMC) was diagnosed. There were 17 patients without a visible lesion that had ablation: six with no prior ER for non-dysplastic Barrett’s, four with low-grade dysplasia, and seven with HGD. The most recent histology following intervention is shown in Table 1. Median length of Barrett’s esophagus in patients with complete eradication or persistent metaplasia/dysplasia was not significantly different (2 vs. 2.5, p=0.1860). In 7 of the 12 patients with complete eradication, their chronic reflux was treated with a laparoscopic fundoplication. In 3 patients an esophagectomy was performed for persistent HGD. There was no significant bleeding after ER, and the single perforation was successfully treated with a stent. There has been no cancer recurrence after a median follow-up of 29 months (IQR 11-38). Conclusion:ER is an effective technique to stage superficial esophageal lesions and aids selection of patients for esophagectomy or esophageal preservation. HGD and IMC can be successfully treated in selected patients with ER and/or ablation. Complete elimination of long segments of Barrett’s is difficult, but no patient treated with endoscopic therapy has died from esophageal cancer.
Table 1 Pathologic Diagnosis of most recent Biopsy after ET*

Diagnosis	n	Nr. of Treatments ER/ablation	Histology at Time of last Biopsy
			IMC	HGD	LGD/IM	No IM
IMC	9	35/12	1	1	1	6
HGD	18	26/23	0	12	0	6
Others (LGD, IM,...)	17	12/22	0	0	6	11

IMC (intramucosal cancer), HGD (high-grade dysplasia), LGD (low-grade dysplasia), IM (intestinal metaplasia)* patients with no biopsy since initial ET were excluded