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Barrett’s Esophagus and Cancer Risk: How Research Advances Can Impact Clinical Practice

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Barrett’s esophagus (BE) is the only known precursor toesophageal adenocarcinoma (EAC), whose incidence hasincreased sharply in the last 4 decades. The annual conversionrate of BE to cancer is significant, but small. The identificationof patients at a higher risk of cancer therefore poses aclinical conundrum. Currently, endoscopic surveillance is recommendedin BE patients, with the aim of diagnosing eitherdysplasia or cancer at early stages, both of which are curablewith minimally invasive endoscopic techniques. There is alarge variation in clinical practice for endoscopic surveillance,and dysplasia as a marker of increased risk is affected bysampling error and high interobserver variability. Screeningprograms have not yet been formally accepted, mainly dueto the economic burden that would be generated by uppergastrointestinal endoscopy. Screening programs have not yetbeen formally accepted, mainly due to the economic burdenthat would be generated by widespread indication to uppergastrointestinal endoscopy. In fact, it is currently difficult toformulate an accurate algorithm to confidently target thepopulation at risk, based on the known clinical risk factorsfor BE and EAC. This review will focus on the clinical andmolecular factors that are involved in the development of BEand its conversion to cancer and on how increased knowledgein these areas can improve the clinical management ofthe disease

Abstract

Barrett’s esophagus (BE) is the only known precursor toesophageal adenocarcinoma (EAC), whose incidence hasincreased sharply in the last 4 decades. The annual conversionrate of BE to cancer is significant, but small. The identificationof patients at a higher risk of cancer therefore poses aclinical conundrum. Currently, endoscopic surveillance is recommendedin BE patients, with the aim of diagnosing eitherdysplasia or cancer at early stages, both of which are curablewith minimally invasive endoscopic techniques. There is alarge variation in clinical practice for endoscopic surveillance,and dysplasia as a marker of increased risk is affected bysampling error and high interobserver variability. Screeningprograms have not yet been formally accepted, mainly dueto the economic burden that would be generated by uppergastrointestinal endoscopy. Screening programs have not yetbeen formally accepted, mainly due to the economic burdenthat would be generated by widespread indication to uppergastrointestinal endoscopy. In fact, it is currently difficult toformulate an accurate algorithm to confidently target thepopulation at risk, based on the known clinical risk factorsfor BE and EAC. This review will focus on the clinical andmolecular factors that are involved in the development of BEand its conversion to cancer and on how increased knowledgein these areas can improve the clinical management ofthe disease

참고문헌 (133)

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