Use of lasers in Barrett's esophagus.

Lasers are used in the management of Barrett's esophagus for specific tasks. First is for the ablation of non-dysplastic and dysplastic Barrett's as part of an aggressive, minimally invasive, yet unproven preventive interventional strategy for both low-risk and high-risk of progression subgroups. Secondly is for potentially curative treatment of early mucosal cancers (Tis and T1mN0M0). Finally, lasers are used for palliation of dysphagia for advanced tumors. The first two laser uses should be considered experimental and undertaken in the setting of an institutionally approved research protocol. Paramount to the success of ablation of dysplastic and early cancerous Barrett's is careful selection of patients by meticulous video endoscopic inspection of the mucosa, use of high frequency and dedicated endosonography (to uncover unsuspected tumors that penetrate the submucosa or involve lymph nodes that cannot be targeted by laser treatment), and experienced GI pathologists. Lasers can also play an important adjuvant role in the management of dysphagia for advanced cancers: however, the specific patients' characteristics for this group of patients is currently not well-defined in this era of easily placed expandable metallic stents.