Summary
Multipolar electrocoagulation (MPEC) ablation is a simple-to-use, familiar, widely available, inexpensive, and safe option for the endoscopic treatment of Barrett’s epithelium. While its use has primarily been tested in non-dysplastic Barrett’s epithelium, it may also be of value in non-nodular low-grade and high-grade dysplasia. It can achieve endoscopic and histologic ablation in at least 70–80% of the treated patients, with successful ablation typically achieved within three to four ablation procedures. Head-to-head comparisons with other thermal ablative techniques such as APC show the two techniques to be similar, although a non-statistically significant trend to improved efficacy was seen favoring MPEC. Successful acid suppression appears to be helpful in achieving effective ablation with this technique. Future studies comparing this technique with alternative ablation modalities, assessing its durability and the need for continued surveillance in successfully ablated patients, and evaluating whether ablation reduces the risk of subsequently developing adenocarcinoma are needed. Given these uncertainties, its use at present may best be limited to ablating residual short/limited areas of non-nodular Barrett’s esophagus with high-grade dysplasia or early cancer.