Management of nondysplastic barrett esophagus with ablation therapy.

RS Management of nondysplastic Barrett esophagus has consisted of interval endoscopy with systematic biopsies (4 quadrants every 2 cm). Although this procedure has been routinely practiced for many years, analyses have shown that it is not cost-effective. There has also been a problem with the method of biopsies. Biopsies can be time-consuming, particularly when segments of Barrett esophagus are 5 cm or longer. Studies have shown that the longer a segment of Barrett esophagus is, the fewer biopsies an endoscopist takes every 2 cm. For example, a 10-cm Barrett esophagus would probably require 6 levels of 4-quadrant biopsies, for a total of 24 biopsies. However, it is unlikely that the average practitioner would take so many biopsies, as they would require an extra 15–20 minutes. In addition, each level of specimens must be placed in a separate bottle after being obtained, so more than 1 assistant is needed during the procedure—an additional person is necessary to manage all of the biopsies. More biopsies also translate into higher costs from the pathologist.