Barrett's esophagus: Diagnosis and management

Barrett’s esophagus (BE) occurs when the stratified squamous epithelium is replaced by metaplastic columnar epithelium due to long-standing gastroesophageal reflux disease. BE is typically found during endoscopic examinations of middle-aged and older adults, but many cases go undetected. BE can progress from non-dysplastic BE (NDBE) to low-grade dysplasia (LGD) and high-grade dysplasia (HGD), and eventually invasive carcinoma. The current gold standard to diagnose BE is via esophagogastroduodenoscopy (EGD) with biopsy. The evolution of NDBE to esophageal adenocarcinoma (EAC) is low, approximately 0.2-0.3% annually, therefore surveillance endoscopy is recommended every 3-5 years. LGD is treated with endoscopic eradication therapy via radiofrequency ablation (RFA). Patients with confirmed HGD or early cancer in BE should be treated with endoscopic therapy, preferably resection followed by mucosal ablation. Endoscopic resection should be performed for any visible mucosal lesions and irregularities with either EMR or ESD and mucosal ablation with RFA/hybrid APC/cryotherapy with the aim of eliminating all the dysplastic and metaplastic tissue. Biomarker panels are currently being investigated to aid with the diagnosis of BE and help the risk stratification of BE during surveillance, but further research will be required to refine these markers in screening, diagnosis, and surveillance.