Diagnosis and treatment of Barrett's oesophagus.

INTRODUCTION

Barrett's oesophagus (BO) is a common premalignant condition, which carries a risk of progression to oesophageal adenocarcinoma. Recent advances include quantifying the risk of neoplasia progression, novel diagnostic tools and development of new endoscopic techniques to treat early Barrett's cancer.

SOURCES OF DATA

A selective search was performed on recent advances in BO and this was supplemented with guidelines from the American and British Society of Gastroenterology.

AREAS OF AGREEMENT

All cases of dysplasia should be confirmed by a second expert histopathologist. Endoscopic therapy is the preferred option for high-grade dysplasia and intra-mucosal (T1a) carcinoma using endomucosal resection (EMR) and/or radiofrequency ablation. EMR also provides accurate staging information and any remaining Barrett segment should be ablated to reduce the risk of metachronous lesions.

AREAS OF CONTROVERSY

The cell of origin for BO is not certain. The merits and cost effectiveness of endoscopic screening and surveillance still remain controversial. The risk of neoplasia progression in low-grade dysplasia is inconsistently reported. The role of chemoprevention remains unclear.

GROWING POINTS

The use of radical endotherapy in early Barrett's neoplasia is promising with some data supporting long-term durability.

AREAS TIMELY FOR DEVELOPING RESEARCH

The development of non-endoscopic diagnostic tools and radical endotherapy to treat early cancer strengthens the argument for surveillance and suggests the possibility of screening in the near future. Identification of a biomarker may help to select high-risk patients.