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Barrett’s Esophagus

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Gastrointestinal Endoscopy

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Abstract

Barrett’s esophagus (BE) is the replacement of stratified squamous epithelium of the distal esophageal mucosa with columnar epithelium with intestinal metaplasia. It is the only known premalignant condition that predisposes to the development of esophageal adenocarcinoma. The incidence of esophageal adenocarcinoma has increased several folds over the last few years, and it is associated with a poor prognosis when diagnosed late. Endoscopic screening and surveillance of patients with BE is done to detect the progression to cancer and to treat it at an early stage. BE is diagnosed by endoscopy and biopsy. The standard endoscopic procedures include noting the circumferential and maximal extent of BE, characterization of visible lesions by Paris classification and rigorous four-quadrant random biopsy. Advanced imaging techniques, such as chromoendoscopy, auto-fluorescence imaging, narrow-band imaging, optical-coherence tomography and confocal endomicroscopy, aid in the diagnosis of dysplasia.

BE progresses through stages of non-dysplastic BE (NDBE), low-grade dysplasia (LGD), high-grade dysplasia (HGD), and esophageal adenocarcinoma (EAC). The risk of cancer progressively increases through each of the stages of dysplasia and is 6.6 % in patients with HGD. Patients with HGD are, therefore, treated with endoscopic therapies to reduce the risk of their progression to cancer.

A number of endoscopic techniques are available for the eradication of dysplasia; multi-polar electrocoagulation, argon plasma coagulation, photodynamic therapy, cryotherapy, radiofrequency ablation (RFA), and endoscopic mucosal resection (EMR). EMR of visible lesions and RFA of remaining BE is the current standard practice and results in eradication of > 90 % of BE epithelium. Strictures are the most common complication and are seen in 5 % of the patients undergoing RFA. Recurrence is seen in one fourth of the patients and underscores the need for continued surveillance even after the treatment. Long-term efficacy studies are needed to assess the impact of endoscopic eradication. In the future, peptide-based imaging, Raman spectroscopy, biomarker panels, and genomic sequencing will be used in managing these patients.

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Authors and Affiliations

  1. Kansas City Veterans Affairs Medical Center, 64128, Kansas City, MO, USA

    Vijay Kanakadandi & Prateek Sharma

  2. Kansas University Medical Center, Kansas City, KS, USA

    Prateek Sharma

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  1. Vijay Kanakadandi
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  2. Prateek Sharma
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Correspondence to Prateek Sharma .

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  1. Department of Gastroenterology, Saint Luke’s Health System, Kansas City, Missouri, USA

    Sreenivasa S. Jonnalagadda

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Kanakadandi, V., Sharma, P. (2015). Barrett’s Esophagus. In: Jonnalagadda, S. (eds) Gastrointestinal Endoscopy. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2032-7_1

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