Diagnosis and recognition of early esophageal neoplasia

Barrett's esophagus (BE) is the precursor lesion of esophageal adenocarcinoma, a malignancy with increasing incidence in Western countries. Malignant transformation of Barrett's metaplasia is a multistep process in which intestinal metaplasia progresses through low-grade and high-grade dysplasia into eventually invasive cancer. Several risk factors for the development of BE have been identified. The degree of dysplasia is currently used as the most important marker of risk progression. The exact incidence of progression from BE to esophageal adenocarcinoma is unknown. Endoscopic surveillance and follow-up are advised in order to detect adenocarcinoma and its precursor precancerous lesions at an early and curable stage, although there has been much debate on this topic. New endoscopic imaging techniques may improve the detection of relevant precancerous lesions and early neoplasia. The use of biomarkers may enable identification of patients at risk for malignant progression.