Abstract
SummaryBackgroundBarrett’s esophagus (BE) is the premalignant manifestation of gastroesophageal reflux disease (GERD). Radiofrequency ablation (RFA) with and without endoscopic resection (ER) is a novel treatment for BE.MethodsHere we present a single-center update of the recommendations of a recent (June 2015) interdisciplinary expert panel meeting on the management of BE with dysplasia as well as cancer-positive and cancer-negative BE. We conducted a PubMed search of studies published in 2016 and 2017 on the topic of BE and RFA.ResultsOur update reconfirms that BE positive for T1a cancer as well as low- and high-grade dysplasia justifies the use of RFA ± ER, offering an 80–100% rate of BE clearance. RFA ± ER of dysplastic BE is tenfold more effective for cancer prevention when compared with surveillance. Risk factors for recurrence and follow-up treatments include baseline histopathology (dysplasia/T1a cancer), esophagitis, hiatal hernia >3 cm, smoking habits, BE segments >3 cm, and >10 years of GERD symptoms. A baseline diagnosis for dysplasia and T1a cancer should include a second expert pathologist opinion. Recent data justify the use of RFA for nondysplastic BE only in controlled clinical trials. Antireflux surgery can be offered to those with function-test-proven, GERD-symptom-positive BE before, during, or after RFA ± ER. Additionally, there is growing evidence that the intake of a sugar-rich diet is positively correlated with the development of GERD, BE, and cancer.ConclusionRFA ± ER should be offered for dysplastic BE and T1a cancer after ER as well as for nondysplastic BE with additional risk factors in controlled trials. Antireflux surgery can be offered to patients with function-test-proven GERD-symptom-positive BE. Diet considerations should be included in the management of GERD and BE.
Highlights
Barrett’s esophagus (BE) represents the morphologic premalignant manifestation of gastroesophageal reflux disease (GERD), which develops as a consequence of the dysfunction and failure of the antireflux mechanism within the lower end of the esophagus ([1]; Fig. 1)
Via low- (LGD) and high-grade dysplasia (HGD), nondysplastic BE may progress toward adenocarcinoma of the esophagus
The endoscopic management (RFA ± endoscopic mucosa resection (EMR)) of dysplastic BE offers an accurate pretreatment diagnosis, is approximately tenfold superior to surveillance for cancer prevention [10], warrants accurate follow-up (± Radiofrequency ablation (RFA) ± endoscopic surgery; [4, 6]), and should be conducted in expert specialized centers [3]
Summary
Barrett’s esophagus (BE) represents the morphologic premalignant manifestation of gastroesophageal reflux disease (GERD), which develops as a consequence of the dysfunction and failure of the antireflux mechanism within the lower end of the esophagus ([1]; Fig. 1). Via low- (LGD) and high-grade dysplasia (HGD), nondysplastic BE may progress toward adenocarcinoma of the esophagus Radiofrequency ablation (RFA; Fig. 3) and endoscopic mucosal and submucosal resection are treatment modalities for the durable eradication of BE, dysplasia, and early cancer and have been demonstrated to foster cancer prevention [2, 3]. A recent Austrian multidisciplinary expert panel meeting held in Vienna in June 2015 summarized recommendations for the management of BE [3]. We aim to summarize and update the recommendation by inclusion of relevant studies published in 2016. 282 Update on the management of Barrett’s esophagus in Austria.
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