One cannot underestimate the technical requirements involved in this treatment. In the report of the study by Huberty et al,14 it is emphasized that only “expert endoscopists” performed this procedure. Although this is not mentioned in this report, some authors have noted that an average of 60 minutes is required

to perform flexible cricopharyngeal myotomy.12 Endoscopic cricopharyngeal myotomy shares common techniques and tools that can be borrowed from those used to perform endoscopic mucosal dissection18 (eg, hook-knife8 [Fig. 1B]) and peroral endoscopic myotomy.19 With advancements and increased use of these techniques, experienced therapeutic endoscopists should be well equipped to perform transoral flexible endoscopic therapy of ZD. Overall, we believe that the work by Huberty et al14 FXR agonist provides strong support for transoral flexible endoscopic treatment of ZD and the opportunity for gastroenterologists to expand their therapeutic armamentarium. Although one might perceive this as an infringement on the turf of surgeons, it is more an opportunity for greater collaboration because some patients will clearly be best served with a traditional anti-CTLA-4 antibody surgical approach as the initial treatment as well as failures and recurrences after flexible endoscopic therapy. It also may be that the ultimate endoscopic approach evolves from

a combination of gastroenterological and surgical techniques. Until that point, selected expert therapeutic endoscopists may carefully consider developing this therapy for their patients but with the caveats noted previously. Ideally, properly oxyclozanide performed comparative trials of transoral flexible endoscopic and rigid endoscopic myotomy are needed. The authors disclosed no financial relationships

relevant to this publication. “
“Esophageal adenocarcinoma (EAC) is a highly lethal cancer and continues to be the most rapidly increasing cancer in the United States and the Western world.1 The availability of effective and relatively easy to use endoscopic eradication therapy for Barrett’s esophagus (BE)–associated high-grade dysplasia (HGD) and early esophageal adenocarcinoma (EAC) makes a compelling argument for accurate and timely detection of dysplasia/cancer in BE. White-light endoscopy (WLE) can detect visible lesions within the BE segment but relies on random biopsies for detection of inconspicuous flat dysplasia/cancer. Random sampling of BE mucosa not only adds to missed opportunities for intervention, but also to the cost by requiring a greater number of biopsies. This has led to evaluation and application of novel imaging techniques such as autofluorescence imaging (AFI) and narrow-band imaging (NBI). However, their use is limited mostly to tertiary referral centers because of the challenges associated with recognition of abnormal/irregular patterns detected by these novel techniques.