Barrett's adenocarcinoma of the esophagus: better outcomes through new methods of diagnosis and treatment

Abstract

Background: Esophageal adenocarcinoma has attracted more attention among gastroenterologists recently because of its rapidly rising incidence in Western countries. Many new epidemiological findings have been published, and there have been numerous technical advances in diagnostic procedures and in multimodal treatment based on the staging of the disease.

Methods: In this paper, we selectively review the literature on esophageal adenocarcinoma, also considering the evidence-based recommendations contained in the guidelines of the German Society for Digestive and Metabolic Diseases (Deutsche Gesellschaft für Verdauungs- und Stoffwechselkrankheiten, DGVS) as well as the latest data from our own research team.

Results and conclusion: here have been major recent advances in the diagnosis and treatment of esophageal adenocarcinoma. New refinements in endoscopic techniques now make endoscopic treatment possible for early esophageal carcinoma. New surgical techniques and new strategies of neoadjuvant chemotherapy have lowered the morbidity and improved the outcome of patients with locally advanced disease. Molecular therapies, too, have shown promising initial results.

Figure 1

Chromoendoscopy using acetic acid: early neoplasia in Barrett’s esophagus

Figure 2

Endoscopic four-field resection of a large-surface-area early Barrett’s adenocarcinoma

Figure 3

Histological stages and lymph node involvement in 130 patients with surgically treated early Barrett’s carcinoma (June 2000 to June 2009, pT1m 7.8%, pT1sm1 9.6%, pT1sm2 25%, pT1sm3 27%) and lymph node positivity in 899 patients with endoscopically treated mucosal carcinomas (0.34%) and 120 patients with sm1 carcinomas (2.5%)

Figure 4

Overall survival (Kaplan–Meier) of surgically treated patients with early Barrett’s carcinoma in relation to lymph node involvement (n = 130, p 0.001)