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Management controversies in Barrett’s oesophagus

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Abstract

The management of Barrett’s oesophagus and associated neoplasia has evolved considerably in recent years. Modern endoscopic strategies including endoscopic resection and mucosal ablation can eradicate dysplastic Barrett’s and prevent progression to invasive oesophageal cancer. However, several aspects of Barrett’s management remain controversial including the stage in the disease process at which to intervene, and the choice of endoscopic or surgical therapy. A review of articles pertaining to the management of Barrett’s oesophagus with or without associated neoplasia, was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Medline, Embase and Cochrane databases were searched to identify literature relevant to eight pre-defined areas of clinical controversy. The following search terms were used: Barrett’s oesophagus; dysplasia; intramucosal carcinoma; endotherapy; endoscopic resection; ablation; oesophagectomy. A significant body of evidence exists to support early endoscopic therapy for high-grade dysplasia (HGD). Although not supported by randomised controlled trial evidence, endoscopic therapy is now favoured ahead of oesophagectomy for most patients with HGD. Focal intramucosal (T1a) carcinomas can be managed effectively using endoscopic and surgical therapy, however surgery should be considered the first line therapy where there is submucosal invasion (T1b). Treatment of low grade dysplasia is not supported at present due to widespread over-reporting of the disease. The role of surveillance endoscopy in non-dysplastic Barrett’s remains controversial.

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Acknowledgments

Professor Hugh Barr is Chief Investigator of BOSS funded by the NIHR HTA, and a PI for ChOPIN. Both authors are involved in data collection for OCCAMS. Mr Max Almond acknowledges Research Fellowship funding from the Royal College of Surgeons of England.

Conflict of interest

The authors declare that they have no conflict of interest.

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  1. Department of Upper GI Surgery, Leadon House, Gloucestershire Royal Hospital, Great Western Road, Gloucester, Gloucestershire, GL1 3NN, UK

    L. Max Almond & Hugh Barr

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  1. L. Max Almond
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  2. Hugh Barr
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Correspondence to L. Max Almond.

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Max Almond, L., Barr, H. Management controversies in Barrett’s oesophagus. J Gastroenterol 49, 195–205 (2014). https://doi.org/10.1007/s00535-013-0816-z

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  • DOI: https://doi.org/10.1007/s00535-013-0816-z

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