How would you manage long-segment Barrett's esophagus with both LGD and HGD that has failed to respond to RFA, cryoablation, or even Nissen fundoplication for large hiatal hernia?

ESD/multifocal EMR followed by may be a great option to assess T-stage/rule out occult esophageal cancer. However, the challenge with a large hiatal hernia is ongoing severe GERD and persistent esophagitis. This is a known risk factor for lack of response to endoscopic ablative and resection therapi...

EMR/ESD

In this scenario, with failure of RFA as well as cryoablation, it would seem that the only other option would be esophagectomy. If the patient is opposed to the surgical route, I would bring the patient back and consider cryoballoon, rather than cryospray for the high-risk areas revealed by acetic a...