[Surveillance of patients with Barrett's esophagus]

Barrett's esophagus is a major complication of gastroesophageal reflux disease and is associated with 30-125 fold increased risk of developing carcinoma. Because of the rising incidence of esophageal adenocarcinoma the malignant potential of Barrett's esophagus has been generally recognized. The definition of Barrett's esophagus has evolved over the last decades. It is now accepted that "Long-Barrett-Segment" (LBS) is used when intestinal-type epithelium, characterized by the presence of goblet cells, is detected in the distal esophagus > 3 cm in length. The term "Short-Barrett-Segment" (SBS) is defined by intestinal metaplasia detection < 3 cm in length in the distal esophagus. Recently, there has been focus on microscopic Barrett's esophagus, so called "Ultra-Short-Barrett's esophagus", with histological evidence of intestinal metaplasia without endoscopic appearance. The most significant predictor of the risk of malignancy in patients with Barrett's esophagus is the presence of dysplasia. Guidelines for surveillance are based on the diagnosis of dysplastic lesions. New methods (e. g. Methylene blue staining, endoscopic fluorescence detection, OCT) to improve the recognition of Barrett's esophagus and especially enhance the detection of premalignant and malignant lesions are under evaluation. So far, the standard biopsy protocol for patients with LBS includes biopsies in the 4 quadrants every 1-2 cm, whereas the appropriate surveillance intervals are dependent on the grade of dysplasia. Whether surveillance in patients with SBS has to be similar to that in patients with LBS is unclear and needs further evaluation.