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Barrett’s esophagus

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Opinion Statement

Patients who develop Barrett’s esophagus should be entered into an endoscopic surveillance program, including endoscopic biopsy.

For patients who do not develop dysplasia, we recommend surveillance every 3 years. Patients with low-grade dysplasia should be surveyed with endoscopy and biopsy every 6 months over the next year, then at 1-year intervals if there has not been progression to a higher grade of dysplasia.

The role of endoscopic ablation therapy has yet to be defined.

Because of the high risk (30% to 40%) of developing esophageal cancer among patients with high-grade dysplasia, we recommend esophagectomy for those who are medically fit to undergo this surgery. However, it is important that an expert pathologist confirms the diagnosis and that the operation is performed by a surgeon experienced in esophageal resection.

For those who are not candidates for surgery or refuse it, we recommend consideration of endoscopic ablative therapy. The other option available is to continue surveillance at 3- to 6-month intervals with reconsideration of surgical or experimental ablative therapy if cancer develops (see Figure 1).

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References and Recommended Reading

  1. Hamilton SR: Pathogenesis of columnar cell-lined (Barrett’s) esophagus. In Barrett’s Esophagus: Pathophysiology, Diagnosis, and Management. Edited by Spechler SJ, Goyal RK. New York: Elsevier Science; 1985:29–37.

    Google Scholar 

  2. Blot WJ, Devesa SS, Kneller RW, et al.: Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 1991, 265:1287–1289.

    Article  PubMed  CAS  Google Scholar 

  3. Blot WJ, Devesa SS, Fraumeni JF: Continuing climb in rates of esophageal adenocarcinoma: an update. JAMA 1993, 270:1320.

    Article  PubMed  CAS  Google Scholar 

  4. Sampliner RE: Practice guidelines on the diagnosis, surveillance, and therapy of Barrett’s esophagus. Am J Gastroenterol 1998, 93:1022–1032.

    Article  Google Scholar 

  5. Levine DS, Haggitt RC, Irvine S, et al.: Natural history of high-grade dysplasia in Barrett’s esophagus. Gastroenterology 1996, A550.

  6. Rice TW, Falk GW, Achkar E, et al.: Surgical management of high-grade dysplasia in Barrett’s esophagus. Am J Gastroenterol 1993, 88:1832–1836.

    PubMed  CAS  Google Scholar 

  7. Heitmiller RF, Redmond M, Hamilton SR: Barrett’s esophagus with high-grade dysplasia: An indication for prophylactic esophagectomy. Ann Surg 1996, 224:66–71. Consecutive patients with Barrett’s esophagus and high-grade dysplasia underwent esophagectomy. Thirteen of 30 patients had adenocarcinoma identified in the resected specimen. Eight of these patients had stage I cancer; seven of the eight were alive at a mean of 18 months’ follow-up.

    Article  PubMed  CAS  Google Scholar 

  8. Reid BJ, Weinstein WM, Lewin KJ, et al.: Endoscopic biopsy can detect high-grade dysplasia or early adenocarcinoma in Barrett’s esophagus without grossly recognizable neoplastic lesions. Gastroenterology 1988, 94:81–90.

    PubMed  CAS  Google Scholar 

  9. Hameeteman W, Tytgat GNJ, Houthoff HJ, et al.: Barrett’s esophagus: development of dysplasia and adenocarcinoma. Gastroenterology 1989, 96:1249–1256.

    PubMed  CAS  Google Scholar 

  10. Peters JH, Clark GW, Ireland AP, et al.: Outcome of adenocarcinoma arising from Barrett’s esophagus in endoscopically surveyed and nonsurveyed patients. J Thorac Cardiovasc Surg 1994, 108:813–822.

    PubMed  CAS  Google Scholar 

  11. Lee RG: Dysplasia in Barrett’s esophagus. Am J Surg Pathol 1985, 9:845–852.

    Article  PubMed  CAS  Google Scholar 

  12. Altorki NK, Sunagawa M, Little AG, et al.: High-grade dysplasia in the columnar-lined esophagus. Am J Surg 1991, 161:97–100.

    Article  PubMed  CAS  Google Scholar 

  13. Pera M, Trastek VF, Carpenter HA, et al.: Barrett’s esophagus with high-grade dysplasia: An indication for esophagectomy? Ann Thorac Surg 1992, 23:199–203.

    Article  Google Scholar 

  14. Levine DS, Haggitt RC, Blount PL, et al.: An endoscopic biopsy protocol can differentiate high-grade dysplasia from early adenocarcinoma in Barrett’s esophagus. Gastroenterology 1993, 105:40–50.

    PubMed  CAS  Google Scholar 

  15. McArdle JE, Lewin KJ, Randall G, et al.: Distribution of dysplasia and early invasive carcinoma in Barrett’s esophagus. Hum Pathol 1992, 23:479–482.

    Article  PubMed  CAS  Google Scholar 

  16. Cameron AJ, Carpenter HC, Laukka MA, et al.: Barrett’s esophagus: Pathologic findings following resection for highgrade dysplasia. Am J Gastroenterol 1993, 88:1483.

    Google Scholar 

  17. Edwards MJ, Gable DR, Entsch L, et al.: The rationale for esophagectomy as the optimal therapy for Barrett’s esophagus with high-grade dysplasia. Ann Surg 1996, 223:585–591.

    Article  PubMed  CAS  Google Scholar 

  18. Streitz JM, Andrews CW, Ellis FH: Endoscopic surveillance of Barrett’s esophagus: does it help? J Thorac Cardiovasc Surg 1993, 105:383–388.

    PubMed  Google Scholar 

  19. Reid BJ, Haggitt RC, Rubin CE, et al.: Observer variation in the diagnosis of dysplasia in Barrett’s esophagus. Hum Pathol 1988, 19:166–178.

    Article  PubMed  CAS  Google Scholar 

  20. Overholt BF, Panjehpour M: Photodynamic therapy for Barrett’s esophagus: clinical update. Am J Gastroenterol 1996, 91:1719–1723. Patients with Barrett’s esophagus and dysplasia or superficial carcinoma were treated with photodynamic therapy and omeprazole. Twenty-nine of the 36 patients had resolution of the dysplasia or cancer, and 10 had reversal of the columnar epithelium.

    PubMed  CAS  Google Scholar 

  21. Robertson CS, Mayberry JF, Nicholson DA, et al.: Value of endoscopic surveillance in the detection of neoplastic change in Barrett’s oesophagus. Br J Surg 1988, 75:760–763.

    Article  PubMed  CAS  Google Scholar 

  22. Miros M, Kerlin P, Walker N: Only patients with dysplasia progress to adenocarcinoma in Barrett’s oesophagus. Gut 1991, 32:1441–1446.

    PubMed  CAS  Google Scholar 

  23. Reid BJ, Blount PL, Rubin CE, et al.: Flow-cytometric and histological progression to malignancy in Barrett’s esophagus: prospective endoscopic surveillance of a cohort. Gastroenterology 1992, 102:1212–1219.

    PubMed  CAS  Google Scholar 

  24. Schnell T, Sontag SJ, Chejfec G, et al.: High grade dysplasia (HGD) is not an indication for surgery in patients (Pts) with Barrett’s esophagus (dBE). Gastroenterology 1996, A590.

  25. Laukka MA, Wang KK: Initial results using low-dose photodynamic therapy in the treatment of Barrett’s esophagus. Gastrointest Endosc 1995, 42:59–63.

    Article  PubMed  CAS  Google Scholar 

  26. Overholt BF, Panjehpour M: Photodynamic therapy eliminates dysplasia in Barrett’s esophagus. Gastroenterology 1997, 112:A634.

    Google Scholar 

  27. Wang KK, Wong Kee Song LM, Nourbakhsh A, et al.: Can consistent tissue necrosis be achieved during photodynamic therapy for high grade dysplasia or cancer within Barrett’s esophagus? Gastroenterology 1997, 112:A676.

    Google Scholar 

  28. Barr H, Shepherd NA, Roberts DJH, et al.: Eradication of high grade dysplasia in columnar lined (Barrett’s) oesophagus by photodynamic therapy with endogenously generated protoporphyrin IX. Lancet 1996, 348:584–585.

    Article  PubMed  CAS  Google Scholar 

  29. Grossner L, Sroka R, May A, et al.: Photodynamic ablation of severe dysplasia and mucosal cancer in Barrett’s esophagus using 5-ALA. Gastrointest Endosc 1997, 45:AB69.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Gastroenterology Section, Arizona Health Sciences Center and Tucson VA Medical Center, Tucson, AZ

    Thomas G. Morales MD & Richard E. Sampliner MD

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  1. Thomas G. Morales MD
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  2. Richard E. Sampliner MD
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Morales, T.G., Sampliner, R.E. Barrett’s esophagus. Curr Treat Options Gastro 1, 35–39 (1998). https://doi.org/10.1007/s11938-998-0006-x

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  • DOI: https://doi.org/10.1007/s11938-998-0006-x

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