Barrett's esophagus, towards improved clinical practice

Area of Science:

• Gastroenterology
• Oncology
• Endoscopy

Background:

• Barrett's esophagus (BE) arises from chronic gastroesophageal reflux.
• BE carries a risk of progression to esophageal adenocarcinoma (EAC).
• Surveillance is essential after BE diagnosis to detect neoplasia early.

Purpose of the Study:

• To outline the recommended surveillance and management strategies for Barrett's esophagus.
• To detail the role of endoscopy and ablation in managing BE-associated dysplasia and neoplasia.

Main Methods:

• High-definition oral endoscopy with random biopsies is the gold standard for BE diagnosis and surveillance.
• Resection of visible lesions is indicated for low-grade dysplasia (LGD), high-grade dysplasia (HGD), or intramucosal EAC (T1a).
• Endoscopic ablation, such as radiofrequency ablation, is used for BE eradication in specific cases.

Main Results:

• Visible lesions with LGD, HGD, or T1a EAC are curatively resected.
• Residual BE eradication post-resection is achieved through endoscopic ablation.
• Radiofrequency ablation is recommended for eradicating BE without visible lesions but with dysplasia.

Conclusions:

• A structured approach involving endoscopy, resection, and ablation is vital for managing Barrett's esophagus.
• Early detection and intervention significantly improve outcomes for patients with BE-related dysplasia and EAC.
• Effective management strategies can prevent the progression of Barrett's esophagus to invasive cancer.