Barrett’s Esophagus

Introduction

Barrett’s esophagus is the displacement of the squamocolumnar junction proximal to the gastroesophageal junction, with the presence of intestinal metaplasia [1]. The clinical importance of Barrett’s esophagus lies in that it is a risk factor for the development of esophageal adenocarcinoma. The past three decades have seen a significant increase in the incidence of adenocarcinoma of the esophagus and the esophagogastric junction in western countries [2] [3] [4]. Esophageal adenocarcinoma now accounts for more than 50 % of all esophageal cancers in the United States and western Europe [3] [5]. The mortality rate of this malignancy is high and the mean 5-year survival rate in patients with advanced disease is less than 20 % [6] [7]. Over the last several years, Barrett’s esophagus has been the focus of intense clinical research with attempts to unravel various controversial aspects of this lesion such as etiopathogenesis, utility of screening and surveillance, surveillance intervals, treatment of dysplasia, etc. We will summarize here some of the important abstracts relating to different clinical aspects of Barrett’s esophagus that were presented at the 2005 Digestive Diseases Week in Chicago, USA.

References

• 1 Sharma P, McQuaid K, Dent J. et al . AGA Chicago Workshop. A critical review of the diagnosis and management of Barrett’s esophagus: the AGA Chicago Workshop.  Gastroenterology. 2004;  127 310-330
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• 7 Provenzale D, Kemp J A, Arora S, Wong J B. A guide for surveillance of patients with Barrett's esophagus.  Am J Gastroenterol. 1994;  89 670-680
• 8 Jolly A J, Wild C P, Hardie L J. Acid and bile salts induce DNA damage in human esophageal cell lines.  Mutagenesis. 2004;  19 319-324
• 9 Kaur B S, Triadafilopoulos G. Acid- and bile-induced PGE(2) release and hyperproliferation in Barrett’s esophagus are COX-2 and PKC-epsilon dependent.  Am J Physiol. 2002;  283 G327-G334
• 10 Sital R R, de Rooij F W, Kusters J G. et al . Barrett’s esophagus is associated with reflux of secondary bile acids into the esophagus.  Gastroenterology. 2005;  128 A-34
• 11 Sampliner R E,. Practice Parameters Committee of the American College of Gastroenterology . Updated guidelines for the diagnosis, surveillance, and therapy of Barrett’s esophagus.  Am J Gastroenterol. 2002;  97 1888-1895
• 12 Shaheen N, Ransohoff D F. Gastroesophageal reflux, barrett’s esophagus, and esophageal cancer: scientific review.  JAMA. 2002;  287 1972-1981
• 13 Stoltey J, Ullah N, Sahbaie P. et al . Does Barrett’s esophagus develop over time in patients with chronic GERD.  Gastrointest Endosc. 2005;  61 AB103
• 14 Soni A, Sampliner R E, Sonnenberg A. Screening for high-grade dysplasia in gastroesophageal reflux disease: is it cost-effective?.  Am J Gastroenterol. 2000;  95 2086-2093
• 15 Inadomi J M, Sampliner R, Lagergren J. et al . Screening and surveillance for Barrett esophagus in high-risk groups: a cost- utility analysis.  Ann Intern Med. 2003;  138 176-186
• 16 Atkinson M, Das A, Faulx A. et al . Unsedated screening esophagoscopy for Barrett’s esophagus in a primary care VA setting.  Gastrointest Endosc. 2005;  61 AB127
• 17 Ramirez F C, Akins R, Shaukat M. String capsule endoscopy for the screening of Barrett’s esophagus in patients with chronic GERD: a prospective blinded study.  Gastrointest Endosc. 2005;  61 AB141
• 18 Falk G W. Barrett’s esophagus.  Gastroenterology. 2002;  122 1569-1591
• 19 Borovicka J, Fischer J, Neuweiler J. et al . Role of autofluorescence endoscopy in surveillance of Barrett’s esophagus: a prospective multicenter randomized trial.  Gastrointest Endosc. 2005;  61 AB103
• 20 Haringsma J, Poley J, Blok P. et al . Detection of intraepithelial neoplasia in Barrett’s esophagus using autofluorescence endoscopy.  Gastroenterology. 2005;  128 A-52
• 21 Sharma P, Bansal A, Rastogi A. et al . The utility of a novel narrow band imaging (NBI) endoscopy system in patients with Barrett’s esophagus (BE).  Gastrointest Endosc. 2005;  61 AB240
• 22 Kara M, Peters F, Fockens P. et al . Video autofluorescence imaging (AFI) followed by narrow band imaging (NBI) for detection of high grade intraepithelial neoplasia (HGIN) in Barrett’s esophagus (BE).  Gastroenterology. 2005;  128 A-51
• 23 Wang K K, Halling K, Brankley S. et al . The prospective evaluation of fluorescent in situ hybridization (fish) for the detection of dysplasia and adenocarcinoma in Barrett’s esophagus.  Gastroenterology. 2005;  128 A-34
• 24 Borovicka J, Schonegg R, Kradolfer D. et al . Combined digital image cytometry with fluorescence in situ hybridization of brush cytology identifies patients with Barrett’s esophagus at increased risk for neoplastic progression.  Gastrointest Endosc. 2005;  61 AB103
• 25 Reid B J, Prevo L J, Galipeau P C. et al . Predictors of progression in Barrett"s esophagus II: baseline 17p (p53) loss of heterozygosity identifies a patient subset at increased risk for neoplastic progression.  Am J Gastroenterol. 2001;  96 2839-2848
• 26 Bani-Hani K, Martin I G, Hardie L J. et al . Prospective study of cyclin D1 overexpression in Barrett’s esophagus: association with increased risk of adenocarcinoma.  J Natl Cancer Inst. 2000;  92 1316-1321
• 27 Sampliner R E, Fennerty B, Garewal H S. Reversal of Barrett’s esophagus with acid suppression and multipolar electrocoagulation: preliminary results.  Gastrointest Endosc. 1996;  44 532-535
• 28 Sharma P, Weston A, Hall M. et al . A randomized controlled trial of ablation of Barrett’s esophagus with electrocautery vs argon plasma coagulation: long term results.  Gastrointest Endosc. 2005;  61 AB94
• 29 Eisen G M. Ablation therapy for Barrett’s esophagus.  Gastrointest Endosc. 2003;  58 760-769
• 30 Reid B J, Levine D S, Longton G. et al . Predictors of progression to cancer in Barrett’s esophagus: baseline histology and flow cytometry identify low- and high-risk patient subsets.  Am J Gastroenterol. 2000;  95 1669-1676
• 31 Heitmiller R F, Redmond M, Hamilton S R. Barrett’s esophagus with high-grade dysplasia. An indication for prophylactic esophagectomy.  Ann Surg. 1996;  224 66-71
• 32 Falk G W, Rice T W, Goldblum J R. et al . Jumbo biopsy forceps protocol still misses unsuspected cancer in Barrett’s esophagus with high grade dysplasia.  Gastrointest Endosc. 1999;  49 170-176
• 33 Swisher S G, DeFord L, Merriman K W. et al . Effects of operative volume on morbidity, mortality, and hospital use after esophagectomy for cancer.  J Thorac Cardiovasc Surg. 2000;  119 1126-1134
• 34 Mackenzie G, Clark B R, Selvasekar C. et al . Photodynamic therapy with 5 Aminolevulinic acid for high grade dysplasia in Barrett’s esophagus: long term follow up in 51 patients.  Gastroenterology. 2005;  128 AB238
• 35 Wang K, Buttar N, Wongkeesong M. et al . Should complete ablation of Barrett’s esophagus (BE) be the goal of photodynamic therapy (PDT)?.  Gastrointest Endosc. 2005;  61 AB94
• 36 Pech O, May A, Gossner L. et al . Curative endoscopic resection of early esophageal adenocarcinomas (Barrett’s cancer).  Gastrointest Endosc. 2005;  61 AB140
• 37 Cameron A J, Carpenter H A. Barrett’s esophagus, high-grade dysplasia, and early adenocarcinoma: A pathological study.  Am J Gastroenterol. 1997;  92 586-591
• 38 Peters F, Kara M, Rosmolen W. et al . Barrett’s esophagus (BE) with high grade dysplasia (HGD) and/or early cancer (EC): stepwise radical endoscopic resection (SRER) for complete removal of the BE is safe and effective.  Gastrointest Endosc. 2005;  61 AB140