Barrett's oesophagus: how should we manage it?

Area of Science:

• Gastroenterology and Oncology
• Oesophageal disease management

Background:

• Endoscopic surveillance is standard for non-dysplastic Barrett's oesophagus, but its mortality reduction efficacy is unproven.
• Research aims to stratify risk for Barrett's oesophagus progression and identify high-risk individuals.
• The majority of Barrett's oesophagus cases remain undiagnosed, prompting investigation into non-endoscopic screening methods.

Purpose of the Study:

• To review current strategies and emerging research in Barrett's oesophagus management.
• To highlight advancements in risk stratification, screening, chemoprevention, and endotherapy.
• To discuss the role of radiofrequency ablation (RFA) and endoscopic resection in treating dysplasia and early oesophageal adenocarcinoma.

Main Methods:

• Review of current endoscopic surveillance protocols and recent British Society of Gastroenterology (BSG) guidelines.
• Discussion of ongoing research in risk stratification, non-endoscopic screening, and chemoprevention.
• Analysis of evidence supporting endotherapies like radiofrequency ablation (RFA) and endoscopic resection.

Main Results:

• New BSG guidelines incorporate clinicopathological stratification for surveillance intervals.
• Radiofrequency ablation (RFA) is supported for low-grade dysplasia (LGD), emphasizing consensus pathology.
• Endoscopic resection is recommended for visible lesions and T1a tumours.

Conclusions:

• Targeting high-risk Barrett's oesophagus patients can lead to cost-effective surveillance and earlier intervention.
• Advancements in endotherapy, particularly RFA, offer effective treatment options.
• Earlier intervention strategies provide optimism for reducing oesophageal adenocarcinoma mortality.