Diagnosis, Treatment and Follow-Up of Barrett’s Esophagus: A Systematic Review

Abstract

BACKGROUND: Barrett’s esophagus (BE) is a premalignant condition that raises controversy among general practitioners and specialists, especially regarding its diagnosis, treatment, and follow-up protocols. OBJECTIVE: This systematic review aims to present the particularities and to clarify controversies related to the diagnosis, treatment and surveillance of BE. METHODS: A systematic review was conducted on PubMed, Cochrane, and SciELO based on articles published in the last 10 years. PRISMA guidelines were followed and the search was made using MeSH and non-MeSH terms “Barrett” and “diagnosis or treatment or therapy or surveillance”. We searched for complete randomized controlled clinical trials or Phase IV studies, carried out with individuals over 18 years old. RESULTS: A total of 42 randomized controlled trials were selected after applying all inclusion and exclusion criteria. A growing trend of alternative and safer techniques to traditional upper gastrointestinal endoscopy were identified, which could improve the detection of BE and patient acceptance. The use of chromoendoscopy-guided biopsy protocols significantly reduced the number of biopsies required to maintain similar BE detection rates. Furthermore, the value of BE chemoprophylaxis with esomeprazole and acetylsalicylic acid was relevant, as well as the establishment of protocols for the follow-up and endoscopic surveillance of patients with BE based predominantly on the presence and degree of dysplasia, as well as on the length of the follow-up affected by BE. CONCLUSION: Although further studies regarding the diagnosis, treatment and follow-up of BE are warranted, in light of the best evidence presented in the last decade, there is a trend towards electronic chromoendoscopy-guided biopsies for the diagnosis of BE, while treatment should encompass endoscopic techniques such as radiofrequency ablation. Risks of ablative endoscopic methods should be weighted against those of resective surgery. It is also important to consider lifetime endoscopic follow-up for both short and long term BE patients, with consideration to limitations imposed by a range of comorbidities. Unfortunately, there are no randomized controlled trials that have evaluated which is the best recommendation for BE follow-up and endoscopic surveillance (>1 cm) protocols, however, based on current International Guidelines, it is recommended esophagogastroduodenoscopy (EGD) every 5 years in BE without dysplasia with 1 up to 3 cm of extension; every 3 years in BE without dysplasia with >3 up to 10 cm of extension, every 6 to 12 months in BE with low grade dysplasia and, finally, EGD every 3 months after ablative endoscopic therapy in cases of BE with high grade dysplasia.

Эрозивные Эзофагиты При Гастроэзофагеальной Рефлюксной Болезни, Ассоциированные С Ночными Рефлюксами И Сниженным Уровнем Адипонектина

“…Имеется работа, которая противоречит нашим данным. В работе Alves R.J. распространенность пищевода Барретта не отличалась у пациентов с наличием и без ночных симптомов ГЭРБ (средний возраст 57,2 года), но в то же время при однофакторном анализе было продемонстрировано, что молодой возраст, повышенный ИМТ связаны с появлением ночного рефлюкса, а при многофакторном анализе вышеуказанные связи подтвердить не удалось [6]. Другими авторами было показано, что у пациентов с пищеводом Барретта (Ме возраста= 63,6 лет) сильнее выражены кислые рефлюксы в положении лежа на спине по сравнению с пациентами ГЭРБ без пищевода Барретта (Ме возраста= 58,6 лет) [7].…”

Comparação entre o tratamento clínico e cirúrgico do refluxo gastroesofágico nos pacientes com esôfago de Barrett: como o epitélio colunar evolui a longo prazo?

“…Estas são as recomendações estabelecidas pela maioria dos guias práticos das sociedades internacionais (85) . O intervalo de dois anos para o seguimento no EB não displásico é um pouco curto quando comparado com a maior parte das recomendações de seguimento atual pelas sociedades internacionais, como bem colocado por Alves JR em revisão sistemática recente (86) A obesidade foi o principal motivo da contraindicação de tratamento cirúrgico. Sabe-se de longa data a enorme relação da obesidade com o refluxo e com o EB (13,(87)(88)(89) , bem como com o risco de progressão do EB para displasia e AEB (12) .…”