Screening for and surveillance of Barrett's esophagus is clinically indicated

Abstract

Barrett's esophagus (BE) is a complication of chronic gastroesophageal reflux disease (GERD) and is the precursor of esophageal adenocarcinoma (EA), through a progression from intestinal metaplasia (IM), through high-grade dysplasia (HGD). Although the progression from BE to EA seems to be infrequent (0.5% per year), endoscopic and bioptic surveillance would play a significant role in the evaluation of HGD and the detection of EA in early, curable stage, improving survival rates after treatments. The severity and the duration of GERD could be helpful in the assessment of the risk for BE and to enroll these subjects into screening protocols to detect any dysplastic or neoplastic change. The benefits of screening-surveillance programs could be furthermore enhanced by an improvement in diagnostic methods, such as high-resolution endoscopic techniques and the use of biomarkers for the histological examination seems to play a primary role in the cancer risk stratification; in such way, endoscopic resection techniques (mucosal resection and submucosal dissection) can be considered as a helpful method to stage dysplastic changes in BE. Copyright © 2007 S. Karger AG.