Emerging Challenges of Postendoscopy Esophageal Adenocarcinoma and Postendoscopy Esophageal Neoplasia.

Post-endoscopy esophageal neoplasia (PEEN) and post-endoscopy esophageal adenocarcinoma (PEEC) comprise a significant component of all Barrett's esophagus-related neoplasia diagnoses and rates of PEEN/PEEC may be rising. PEEN/PEEC occur primarily due to missed lesions or rapidly progressive disease. Root-cause analysis should be performed for cases and best practices should be implemented to decrease PEEN/PEEC rates - the most important intervention is a high-quality endoscopic exam. Future efforts should determine the role of biomarkers in identifying individuals at high risk of neoplastic progression, develop additional tissue-sampling techniques to reduce missed lesions, and improve education regarding the principles of a high-quality endoscopic examination.