How would you approach endoscopic diagnosis and treatment of an area of visible nodularity concerning for cancer within long segment Barrett’s esophagus?

I would begin by careful inspection of the Barrett's (BE) mucosa under HD-white light and narrow band imaging after washing off the surface mucus. I would evaluate the entire BE segment for nodules, ulcers, irregularities in pit-pattern and focal changes in vascular pattern, raising suspicion for invasive cancer. Reviewing pathology from prior biopsies of the entire BE segment, prior therapy with ablation and resection is important before making a decision on the endoscopic therapy.

If there are one or two discrete nodules within a predominantly flat BE segment without focal areas of abnormal pit/vascular pattern raising concern for invasive cancer, I would resect the nodules using Band-assisted mucosectomy, taking care to overlap the margi...