www.turner-white.com Gastroenterology Volume 15, Part 1 1
Screening, Surveillance, and Management
Michelle H. Lee, MD, and Sharmila Anandasabapathy, MD, AGAF
The incidence of esophageal adenocarcinoma
is rapidly increasing in the United States and
other countries. Population-based cohort studies
examining the incidence of esophageal adenocarcinoma report a 300% to 500% increase over
the past 30 to 40 years.1 Barrett’s esophagus has
gained recognition as the premalignant lesion for
adenocarcinoma and is believed to be the major
risk factor, with a 20-fold increased risk in the development of esophageal adenocarcinoma when
compared to patients without the condition.
reported rate of progression of Barrett’s esophagus to esophageal adenocarcinoma ranges from
0.12% to 0.5% per year.
Barrett’s esophagus is diagnosed in approximately 10% to 15% of patients with reflux symptoms who are undergoing endoscopy.1 Barrett’s
esophagus is defined as a change in the distal
esophageal epithelium of any length that can be
recognized as columnar type mucosa at endoscopy (Figure 1) and is confirmed to have intestinal
metaplasia by biopsy of the esophagus (Figure 2).
If the characteristic “salmon-colored” tongues of
Barrett’s esophagus are observed on standard
light endoscopy, 4-quadrant biopsies should be
taken every 1 to 2 cm throughout the Barrett’s
8 The progression of Barrett’s esophagus
may involve the development of low-grade dysplasia and high-grade dysplasia before the eventual
development of a neoplasm. Because the average
age at diagnosis of esophageal adenocarcinoma
is in the sixth and seventh decades of life,
9 a clear
understanding of the diagnosis and treatment options of Barrett’s esophagus is essential in the care
of the aging population.
A 68-year-old man with a body mass index
of 33 kg/m2 is referred to a gastroenterologist
for evaluation of gastroesophageal reflux disease (GERD). He endorses a history of intermittent substernal burning sensation for the past
• What are indications for screening for Barrett’s esophagus?
Copyright 2014, Turner White Communications, Inc., Strafford Avenue, Suite 220, Wayne, PA 19087-3391, www.turner-white.com. All rights reserved.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, mechanical, electronic, photocopying,
recording, or otherwise, without the prior written permission of Turner White Communications. The preparation and distribution of this publication are supported by sponsorship subject to written agreements that stipulate and ensure the editorial independence of Turner White Communications. Turner White
Communications retains full control over the design and production of all published materials, including selection of topics and preparation of editorial content.
The authors are solely responsible for substantive content. Statements expressed reflect the views of the authors and not necessarily the opinions or policies of
Turner White Communications. Turner White Communications accepts no responsibility for statements made by authors and will not be liable for any errors
of omission or inaccuracies. Information contained within this publication should not be used as a substitute for clinical judgment.