Barrett’s esophagus and Barrett’s carcinoma

Abstract

The rise in the incidence of esophageal adenocarcinomas has raised interest in the precursor lesion Barrett’s esophagus (BE). Carcinogenesis within BE follows a sequence of histopathologic changes. Low-grade intraepithelial neoplasia is the major risk factor for progression to high-grade intraepithelial neoplasia (HG-IN) and invasive carcinoma. Other risk factors are Barrett length and prevalence and size of associated hiatal hernias. Prevention of Barrett’s carcinogenesis by medical or surgical acid suppression has not been proven effective. Chemoprevention with nonsteroidal anti-inflammatory drugs, as well as other molecular-targeted therapies, are promising and currently under investigation. Endoscopic BE ablation is experimental and accompanied by severe side effects. Endoscopic surveillance is recommended for early detection of malignant progression. When the end point of surveillance (HG-IN or carcinoma) is reached, esophagectomy is still standard treatment, although a limited surgical or endoscopic resection can be performed with lower morbidity and favorable long-term results.