J Clin Outcomes Manage
Barrett's esophagus: diagnosis, surveillance, and endoscopic management
Lee MH, Anandasabapathy S
Abstract Objective: To discuss diagnosis, surveillance, and management strategies for Barrett’s esophagus. Methods: Literature review. Results: Barrett’s esophagus has gained recognition as the premalignant precursor for esophageal adenocarcinoma. 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. The challenges to screening include the inability to predict who has Barrett’s esophagus prior to endoscopy, the lack of evidence demonstrating improved mortality and the cost-effectiveness of endoscopic screening. The recommendation for endoscopic surveillance of Barrett’s esophagus is based on the poor overall survival rate for esophageal adenocarcinoma when it is diagnosed at a late stage. Current treatment options for Barrett’s esophagus include surveillance, endoscopic resection, endoscopic ablation therapy and surgical resection. Conclusion: Esophageal adenocarcinoma has been rapidly increasing in incidence in the United States and other countries over the last 30 to 40 years. Controversy still surrounds the screening and surveillance guidelines, but given the poor survival rate for esophageal adenocarcinoma, surveillance endoscopy is endorsed by all major professional gastrointestinal societies. At the current time, patients who are found to have Barrett’s esophagus with high-grade dysplasia or intramucosal esophageal neoplasia have the option of choosing minimally invasive endoscopic procedures, which appear to have comparable efficacy to surgery.
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