www.turner-white.com Gastroenterology Volume 15, Part 1 9
dysplasia. Follow-up endoscopy demonstrates
eradication of high-grade dysplasia.
While the survival rate from esophageal adeno-
carcinoma has improved in recent years, the 5-year
survival rate is still only 15% to 20%.45 Physicians
caring for the aging population must maintain a
high index of suspicion for Barrett’s esophagus in
patients experiencing longstanding symptoms of
reflux, and it is crucial for the physician to refer any
patient in whom they suspect Barrett’s esophagus
or a possible gastrointestinal malignancy to a gas-
troenterologist. The benefits of screening remain
controversial despite continued widespread clini-
cal practice, given the inability to identify high-risk
groups, as well as the lack of proven benefit of
endoscopic surveillance in patients in whom Bar-
rett’s esophagus is identified. Further studies are
needed to clearly define the populations that would
benefit from screening protocols. Patients with dys-
plasia or cancer should be seen in a center with
expertise in the disease. Current treatment options
for Barrett’s esophagus include surveillance, en-
doscopic resection, endoscopic ablation therapy,
and surgical resection. The treatment needs to
be individualized and patient factors such as age,
coexisting medical conditions and personal pref-
erence, as well as the expertise available in the
patient’s community must be taken into consid-
eration. Esophageal characteristics such as the
length of Barrett’s segment, presence of visible
lesions, and the presence of multifocal lesions will
also guide treatment options.66 Currently, patients
who are found to have Barrett’s esophagus with
high-grade dysplasia or intramucosal esophageal
neoplasia have the option of choosing minimally
invasive procedures, which appear to have compa-
rable efficacy to surgery, with the benefits of lower
morbidity and mortality.
1. Shaheen N, Ransohoff DF. Gastroesophageal reflux, Barrett’s esophagus, and esophageal cancer: scientific review.
2. Jung KW, Talley NJ, Romero Y, et al. Epidemiology and
natural history of intestinal metaplasia of the gastroesophageal junction and Barrett’s esophagus: a population-based study. Am J Gastroenterol 2011;106:1447–55.
3. Hvid-Jensen F, Pedersen L, Drewes AM, et al. Incidence of
adenocarcinoma among patients with Barrett’s esophagus.
N Engl J Med 2011;365:1375–83.
4. Solaymani-Dodaran M, Logan RF, West J, et al. Risk of
oesophageal cancer in Barrett’s oesophagus and gastro-oesophageal reflux. Gut 2004;53:1070– 4.
5. Bhat S, Coleman HG, Yousef F, et al. Risk of malignant progression in Barrett’s esophagus patients: results
from a large population-based study. J Natl Cancer Inst
6. Desai TK, Krishnan K, Samala N, et al. The incidence of
oesophageal adenocarcinoma in non-dysplastic Barrett’s
oesophagus: a meta-analysis. Gut 2012;61:970– 6.
7. Alcedo J, Ferrandez A, Arenas J, et al. Trends in Barrett’s
esophagus diagnosis in Southern Europe: implications for
surveillance. Dis Esophagus 2009;22:239–48.
8. Spechler SJ, Sharma P, Souza RF, et al. American
Gastroenterological Association technical review on the
management of Barrett’s esophagus. Gastroenterology
9. Crane SJ, Richard Locke G 3rd, Harmsen WS, et al. The
changing incidence of oesophageal and gastric adenocarcinoma by anatomic sub-site. Aliment Pharmacol Ther
10. ASGE Standards of Practice Committee. The role of endoscopy in Barrett’s esophagus and other premalignant
conditions of the esophagus. Gastrointest Endosc 2012;
11. Inadomi JM, Sampliner R, Lagergren J, et al. Screening
and surveillance for Barrett esophagus in high-risk groups:
a cost-utility analysis. Ann Intern Med 2003;138:176–86.
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