Endoscopic Diagnosis, Screening and Surveillance and Treatment of Barrett’s Esophagus: An Overview.

ABSTRACT

Barrett’s esophagus (BE) is an acquired condition in which the squamous epithelial lining of the lower esophagus is replaced by a columnar epithelium due to chronic gastroesophageal reflux. The prevalence of BE has ranged from 0.9% to 4.5%. The rate of progression from BE to esophageal adenocarcinoma is 0.5% per patient-year. Human studies show that the reflux of bile parallels acid reflux and increases with the severity of gastroesophageal reflux disease (GERD), being most marked in BE. However, recent ex vivo studies suggest that pulses of acid reflux may be more important than bile salts in the development of dysplasia or adenocarcinoma in Barrett’s epithelium. The diagnosis of BE can be suspected when, during endoscopic examination, columnar epithelium is observed to extend above the gastroesophageal junction (GEJ) into the tubular esophagus. Although, guidelines for the diagnosis, surveillance and management of BE were published, the main goal in the management of premalignant condition would be the permanent elimination of Barrett’s mucosa. Current therapeutic options are limited or still in the investigational stages. This review summarizes the endoscopic diagnosis, screening, surveillance and introduces endoscopic ablative modalities currently used.