Diagnosis and therapy of early neoplasia in Barrett's esophagus

In the last 2 years, several studies have been published that will change the management of patients with Barrett's esophagus. In this review, we will discuss the most relevant studies as well as future prospects in this field.

Long-term follow-up studies have shown that to be cost effective, endoscopic surveillance of Barrett's esophagus patients requires a better risk stratification. A decision analysis study suggested that screening for Barrett's esophagus and restricting subsequent surveillance only to patients with dysplasia, might be the preferred strategy. New endoscopic imaging techniques such as high-resolution endoscopy, narrow band imaging, and autofluorescence endoscopy have shown promising results for detection of early mucosal lesions. Endoscopic resection techniques have emerged as a safe and effective alternative for the endoscopic treatment of patients with high-grade intraepithelial neoplasia or early cancer. Ablative techniques such as photodynamic therapy appear to be a valuable adjunct to these endoscopic resection techniques. Recent studies, however, suggest that circumferential stepwise resection of the whole Barrett's mucosa may become the preferred endoscopic treatment in these patients.

Risk stratification, advanced endoscopic imaging techniques, and further development of endoscopic resection techniques will improve the management of patients with Barrett's esophagus in the future.