Published online Jul 28, 2017. doi: 10.3748/wjg.v23.i28.5051
Peer-review started: February 8, 2017
First decision: March 3, 2017
Revised: April 3, 2017
Accepted: July 4, 2017
Article in press: July 4, 2017
Published online: July 28, 2017
Processing time: 174 Days and 21.7 Hours
Oesophageal adenocarcinoma is rapidly increasing in Western countries. This tumour frequently presents late in its course with metastatic disease and has a very poor prognosis. Barrett’s oesophagus is an acquired condition whereby the native squamous mucosa of the lower oesophagus is replaced by columnar epithelium following prolonged gastro-oesophageal reflux and is the recognised precursor lesion for oesophageal adenocarcinoma. There are multiple national and society guidelines regarding screening, surveillance and management of Barrett’s oesophagus, however all are limited regarding a clear evidence base for a well-demonstrated benefit and cost-effectiveness of surveillance, and robust risk stratification for patients to best use resources. Currently the accepted risk factors upon which surveillance intervals and interventions are based are Barrett’s segment length and histological interpretation of the systematic biopsies. Further patient risk factors including other demographic features, smoking, gender, obesity, ethnicity, patient age, biomarkers and endoscopic adjuncts remain under consideration and are discussed in full. Recent evidence has been published to support earlier endoscopic intervention by means of ablation of the metaplastic Barrett’s segment when the earliest signs of dysplasia are detected. Further work should concentrate on establishing better risk stratification and primary and secondary preventative strategies to reduce the risk of adenocarcinoma of the oesophagus.
Core tip: Oesophageal adenocarcinoma is increasing in incidence especially in Western populations. Barrett’s oesophagus is the identifiable pre-malignant condition which allows periodic surveillance and secondary prevention to be undertaken to reduce cancer risk. There has been recent evidence supporting earlier endoscopic intervention for dysplastic changes in Barrett’s oesophagus, but the high burden of surveillance prompts increased efforts to identify individuals at highest cancer risk to concentrate resources on those patients who will derive the greatest benefit.