{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 4, Ep 2 of 3: Endoscopic Eradication Therapy","html":"","width":"100%","height":180,"duration":507,"description":"Endoscopic eradication of Barrett esophagus rests on one principle: the segment holds two kinds of tissue that demand two treatments in a fixed order. Resect visible disease first for a staging specimen, then ablate the flat metaplastic field. This episode covers EMR versus ESD, radiofrequency ablation, cryotherapy salvage, and the intensive post-eradication surveillance that recurrence at the junction and buried glands demands.\n \nTopics covered\n\nResect-first, ablate-second principle\nEndoscopic mucosal resection technique and staging value\nEndoscopic submucosal dissection indications\nRadiofrequency ablation of the flat field\nCryotherapy and salvage modalities\nComplete eradication of intestinal metaplasia\nPost-eradication surveillance and buried glands\nEradication failure and complications\n \n \nKey decisions\n\nAlways resect a visible nodule before ablating; ablating first destroys the specimen that decides endoscopic versus surgical management\nEMR is the staging step because the fuller specimen re-grades forceps biopsies in both directions, most often downgrading high-grade dysplasia\nEn bloc single-piece resection works up to 1.5 to 2 cm; larger lesions or depressed morphology warrant ESD to preserve margins\nRadiofrequency ablation is the default for the flat field; ablation for low-grade dysplasia requires expert-pathologist confirmation\nCryotherapy is the salvage option after RFA fails and suits strictures, very long segments, and burn-intolerant patients\nPost-eradication surveillance is more intensive than before treatment, front-loaded in the first year, biopsying the junction and healed squamous lining for buried glands under twice-daily acid suppression\n \n \nThis is an AI-generated podcast, and some pronunciations may be imperfect. Thank you for your understanding, and we hope you enjoyed this content.\n \n \nStudy the full chapter on Board Pearls, with practice questions, tables and primary-guideline references: Barrett Esophagus and Esophageal Cancer\nRead this...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}