Predictors of Progression in Barrett's Esophagus

To review recently published data on factors that predict the risk of progression of Barrett's esophagus (BE) to high grade dysplasia (HGD) or esophageal adenocarcinoma (EAC).

Computer models have been developed that could help predict the risk of progression with greater accuracy. The progression of BE score (PIB) is one such model based on clinical and endoscopic features, while a second uses automated image analysis of formalin-fixed and paraffin-embedded tissues looking for morphologic features and immunostaining patterns for molecular markers. Panels of genes such as those regulated by Myc and hypermethylated genes have been recently described. EAC remains a cancer with a poor 5-year survival of less than 20%. Screening for BE, the only known precursor of EAC is recommended only in high-risk individuals. Clinical, endoscopic, and molecular predictors of progression have been identified but require validation. These tools could in turn help focus screening and surveillance efforts to reduce mortality from EAC.