Barrett’s early cancer. Should we abandon piecemeal resections?

It is not so long ago that the debate regarding the optimal treatment of Barrett's high grade dysplasia and mucosal cancer was between surgeons advocating esophagectomy and interventional endoscopists demonstrating their results with endoscopic (piecemeal) mucosal resection (EMR) [1]. There is strong evidence to support the idea that piecemeal EMR has the same cancer-related outcomes as esophagectomy with its perfect histology specimen [1]. As such, endoscopic resection has become the first-choice treatment for high grade dysplasia and early cancer in Barrett's esophagus, including in cases with submucosal invasion down to 500 µm (sm1) in the absence of high-risk features such as lymphovascular invasion or poor tumor differentiation.