ESOPHAGEAL CANCER AND BARRETT ESOPHAGUS

Barrett Esophagus

• Columnar metaplasia of esophageal mucosa
• Main known risk factor is Gastroesophageal Reflux/ Reflux Esophagitis
• A possible precursor to esophageal adenocarcinoma
  • Predictors of progression to cancer in an observational study of 108 pts w/Barrett's: dysplasia at dx or any time during f/u, Barrett's > 2cm in length, hiatal hernia 3cm or greater in size (Am. J. Gastroent. 94:3413, 1999--JW)
  • Surveillance with endoscopy for malignant transformation of Barrett's
    • Annual upper endoscopy identified only 1 of 5 pts diagnosed with esophageal Ca over avg. 4.4y f/u in a prospective study of 143 pts with Barrett's esophagus (other 4 cases identified in non-surveillance endoscopies done b/c of sx) (BMJ 321:1238, 2000--JW)
    • In a case series of 166 pts with newly-dx'd BE but no high-grade dysplasia, over mean 6.6y f/u, with surveillance EGD done Q2y on average, 5 pts were eventually diagnosed with esophageal Ca (Am. J. Gastroent. 98:1931, 2003--JW)
    • In a prospective study in 617 pts with BE and at least one follow-up endoscopy, the annual incidence of (esophageal cancer or high-grade dysplasia) was 1.3% (Clin. Gastroent. Hepatol. 4:566, 2006--JW)
• Ablative treatments (e.g. multipolar electrocoagulation, argon-plasma coagulation, radiofrequency ablation) are being explored as treatments as of 2009; the latter has had some success (NEJM 360:2277, 2009-JW)