Monitoring the premalignant potential of Barrett's oesophagus'

Abstract

The landscape for patients with Barrett's oesophagus (BE) has changed significantly in the last decade. Research and new guidelines have helped gastroenterologists to better identify those patients with BE who are particularly at risk of developing oesophageal adenocarcinoma. In parallel, developments in endoscopic image enhancement technology and optical biopsy techniques have improved our ability to detect high-risk lesions. Once these lesions have been identified, the improvements in minimally invasive endoscopic therapies has meant that these patients can potentially be cured of early cancer and high-risk dysplastic lesions without the need for surgery, which still has a significant morbidity and mortality. The importance of reaching an accurate diagnosis of BE remains of paramount importance. More work is needed, however. The vast majority of those undergoing surveillance for their BE do not progress towards cancer and thus undergo a regular invasive procedure, which may impact on their psychological and physical well-being while incurring significant cost to the health service. New work that explores cheaper endoscopic or non-invasive ways to identify the at-risk individual provides exciting avenues for research. In future, the diagnosis and monitoring of patients with BE could move away from hospitals and into primary care.

Keywords: BARRETT'S OESOPHAGUS; ENDOSCOPIC PROCEDURES; SCREENING.

Figure 1

Endoscopic images of Barrett's mucosa (×136 zoom using Pentax iScan surface enhancement imaging). (A) Normal. (B) Dysplastic area after application of 3% acetic acid (AcA), showing typical ‘loss of aceto-whitening’ and distortion of mucosal pattern. This usually becomes clear within 30–60 s of AcA application.