Management of Barrett’s oesophagus and intramucosal oesophageal cancer: a review of recent development

Abstract

Barrett’s oesophagus is the most important and recognizable precursor lesion for oesophageal adenocarcinoma, which is the one of the fastest growing cancers in the Western World. The incidence of oesophageal adenocarcinoma has increased 600% in the United States between 1975 and 2001 and is thought to represent a real increase in burden rather than a result of histologic or anatomical misclassification or overdiagnosis. Thus, the cancer risk in Barrett’s oesophagus has to be managed and involves prevention (surveillance endoscopy), treating underlying gastroesophageal reflux disease (medically and or surgically) and endoscopic therapy to remove diseased epithelium in appropriate patient subgroups. In the last decade, new developments in imaging and molecular markers as well as an armamentarium of novel and effective endoscopic eradication therapy has become available to the endoscopist to combat this exponential rise in oesophageal adenocarcinoma. Paradoxically, the cancer risk in Barrett’s oesophagus gets progressively downgraded which raises fundamental questions about our understanding of the known and unknown risk factors and molecular aberrations that are involved in the Barrett’s metaplasia–dysplasia–carcinoma sequence. Future research has to be directed at these areas to fine tune our screening and surveillance programs to identify more accurately the high-risk group of progressors to oesophageal adenocarcinoma who would benefit most from endoscopic therapy.

Autocrine Extra-Pancreatic Trypsin 3 Secretion Promotes Cell Proliferation and Survival in Esophageal Adenocarcinoma

“…The clinical importance of this relatively common condition relates to its role as a precursor lesion to esophageal adenocarcinoma (EAC), entailing a 100-fold increased risk of developing EAC [1]. BE is associated with chronic gastroesophageal reflux disease (GERD), a chronic regurgitation of gastric fluid into the lower esophagus [2]. The gastric refluxate contains gastric secretions (acid and pepsin) as well as biliary and pancreatic secretions (bile salts and trypsin).…”

Barrett’s Esophagus: Contemporary Diagnostic and Therapeutic Approaches

“…Отсутствие или наличие дисплазии, а также ее степень на сегодняшний день считаются лучшим, но не точным маркером риска развития АК [3]. Значительная разбежка в процентной оценке частоты неопластических процессов в сегменте Барретта в разных исследованиях связана в первую очередь со сложностью трактовки понятия «интраэпителиальная неоплазия» и определения ее степени.…”

“…Так, заболеваемость в Соединенных Штатах в период с 1975 по 2001 гг. увеличилась на 600%, а смертность от данной патологии за этот же период времени выросла более чем в семь раз (с 2 до 15 смертей на миллион взрослого населения, по данным Национального института рака США) [3].…”

Management of oesophageal intramucosal carcinoma

“…An important prognostic factor is late presentation. Barrett’s oesophagus (BO) is the only known precursor to oesophageal adenocarcinoma (OAC) 2. Dysplasia progresses to invasive carcinoma in a stepwise pathway from metaplasia to low-grade dysplasia to high-grade dysplasia (HGD) and to invasive carcinoma 3.…”