Endoscopic Management of Barrett’s Esophagus

Barrett’s esophagus (BE) is a well-recognized premalignant condition for development of esophageal adenocarcinoma (EAC). It is defined as the displacement of the squamo-columnar junction proximal to the gastroesophageal junction, with the presence of intestinal metaplasia (IM) on biopsies (Wang and Sampliner 2008; Sharma et al. 2004). Chronic gastroesophageal reflux disease (GERD) is the most frequent identifiable risk factor for Barrett’s esophagus (Wang and Sampliner 2008; Sharma et al. 2004). In Western populations, BE may be present in approximately 0.4–1.6% of adults, whereas in patients with chronic GERD, the prevalence is approximately 10–15% (Pondugula et al. 2007; Wani and Sharma 2007a). The frequency of EAC in the United States is gradually rising. It has been estimated that 14,550 new cases of esophageal cancer were diagnosed in 2006, with 13,770 deaths related to esophageal cancer, the majority diagnosed at an advanced stage (American Cancer Society 2006). Barrett’s esophagus is considered to be one of the most important identifiable risk factors leading to development of EAC (Menke-Pluymers et al. 1993; Solaymani-Dodaran et al. 2004). Progression of BE to esophageal cancer involves a series of pathological changes, from early nondysplastic columnar epithelium (ND BE) to low-grade dysplasia (LGD), high-grade dysplasia (HGD), and finally to cancer. The mortality associated with EAC is high, with a 5-year survival rate of only 15% (Pondugula et al.2007; Cossentino and Wong 2003; Devesa et al.1998).