Key Points
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The currently used dysplasia grading system for risk stratification of Barrett oesophagus has its limitations
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The lack of standardization, variability in methodology, requirement for special collection media and need for validation in large prospective studies currently precludes the use of biomarkers in routine clinical practice
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Knowledge of easily available endoscopic and histological factors could serve an adjunctive role in risk stratification of patients in both pre-treatment and postendoscopic eradication settings
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Prediction models incorporating clinical–demographic factors in conjunction with biomarkers hold promise for risk stratification of Barrett oesophagus
Abstract
Barrett oesophagus is an important precursor lesion for the development of oesophageal adenocarcinoma (OAC). Upper gastrointestinal endoscopy is the modality most widely used to visualize and biopsy the oesophagus to establish a diagnosis. Additional clues are available at the time of endoscopy that can identify high-risk features known to increase the risk of progression to OAC, such as the length of the Barrett oesophagus segment, length of hiatal hernia and the presence of nodularity or visible endoscopic lesions in this segment. Until molecular biomarkers are identified and validated as adjunctive tools for risk stratification, knowledge of endoscopic features could complement dysplasia grading for risk stratification of patients with Barrett oesophagus and identify subgroups at risk of progression to OAC. This approach would, in turn, facilitate more rational tailoring of endoscopic surveillance. This Review summarizes the current role of endoscopic and histological factors involved in neoplastic progression of Barrett oesophagus to OAC, and provides an overview of the risk-prediction models that have utilized endoscopic and histological factors for risk stratification in patients with Barrett oesophagus.
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Anaparthy, R., Sharma, P. Progression of Barrett oesophagus: role of endoscopic and histological predictors. Nat Rev Gastroenterol Hepatol 11, 525–534 (2014). https://doi.org/10.1038/nrgastro.2014.69
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DOI: https://doi.org/10.1038/nrgastro.2014.69
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