Management of Barrett’s Esophagus
Abstract
Barrett’s esophagus is a precancerous abnormality commonly associated with chronic gastroesophageal reflux
disease (GERD). In this update we briefly review the pathogenesis, risk factors, screening, monitoring and treatment
of the disease. We emphasize the need for early detection and management of Barrett’s esophagus with high grade
dysplasia. Both endoscopic and surgical options for treatment are highlighted. A summary of the results of treatment
from the literature is presented. This review should be useful for busy general surgeons and residents as a quick
refresher on the state-of-the-art knowledge of Barrett’s esophagus.
References
1. Barbera M, Fitzgerald RC. Cellular mechanisms of Barrett’s
esophagus development. Surg Oncol Clin N Am 2009
Jul;18(3):393-410.
2. Nelsen EM, Hawes RH, Iyer PG. Diagnosis and management
of Barrett’s esophagus. Surg Clin North Am 2012 Oct;92(5):
1135-54.
3. Eisen GM, Sandler RS, Murray S, et al. The relationship between
gastroesophageal reflux disease and its complications with
Barrett’s esophagus. Am J Gastroenterol 1997 Jan;92(1):27-
31.
4. Eloubeidi MA, Provenzale D. Clinical and demographic
predictors of Barrett’s esophagus among patients with
gastroesophageal reflux disease: a multivariable analysis in
veterans. J Clin Gastroenterol. 2001 Oct;33(4):306-9.
5. Song S, Guha S, Liu K, et al. COX-2 induction by unconjugated
bile acids involves reactive oxygen species-mediated signaling
pathways in Barrett’s oesophagus and oesophageal
adenocarcinoma. Gut 2007 Nov;56(11):1512-21. Epub 2007
Jun 29.
6. Cook MB, Greenwood DC, Hardie LJ, et al. A systematic
review and meta-analysis of the risk of increasing adiposity on
Barrett’s esophagus. Am J Gastroenterol 2008 Feb;103(2):292-
300.
7. Pandolfino JE, Zhang QG, Ghosh SK, et al. Transient lower
esophageal sphincter relaxations and reflux: mechanistic
analysis using concurrent fluoroscopy and high-resolution
manometry. Gastroenterology 2006 Dec;131(6):1725-33.
8. Chak A, Falk G, Grady WM, et al. Assessment of familiality,
obesity, and other risk factors for early age of cancer diagnosis
in adenocarcinomas of the esophagus and gastroesophageal
junction. Am J Gastroenterol. 2009 Aug;104(8):1913-21.
9. Steffen A, Schulze MB, Pischon T, et al. Anthropometry and
esophageal cancer risk in the European prospective
investigation into cancer and nutrition. Cancer Epidemiol
Biomarkers Prev. 2009 Jul;18(7):2079-89.
10. Corley DA, Kubo A, Zhao W. Abdominal obesity and the risk
of esophageal and gastric cardia carcinomas. Cancer
Epidemiol Biomarkers Prev 2008 Feb;17(2):352-8.
11. Chak A, Lee T, Kinnard MF, et al. Familial aggregation of
Barrett’s oesophagus, oesophageal adenocarcinoma, and
oesophagogastric junctional adenocarcinoma in Caucasian
adults. Gut 2002 Sep;51(3):323-8.
12. Chak A, Ochs-Balcom H, Falk G, et al. Familiality in Barrett’s
esophagus, adenocarcinoma of the esophagus, and
adenocarcinoma of the gastroesophageal junction. Cancer
Epidemiol Biomarkers Prev 2006 Sep;15(9):1668-73.
13. Chak A, Chen Y, Vengoechea J, et al. Variation in age at
cancer diagnosis in familial versus nonfamilial Barrett’s
esophagus. Cancer Epidemiol Biomarkers Prev 2012
Feb;21(2):376-83.
14. Sun X, Elston R, Barnholtz-Sloan J, et al. A segregation analysis
of Barrett’s esophagus and associated adenocarcinomas.
Cancer Epidemiol Biomarkers Prev 2010 Mar;19(3):666-74.
15. Wang KK, Sampliner RE; Practice Parameters Committee of
the American College of Gastroenterology. Updated
guidelines 2008 for the diagnosis, surveillance and therapy of
Barrett’s esophagus. Am J Gastroenterol 2008 Mar;103(3):
788-97.
16. Eloubeidi MA, Provenzale D. Does this patient have Barrett’s
esophagus? The utility of predicting Barrett’s esophagus at
the index endoscopy. Am J Gastroenterol 1999 Apr;94(4):937-
43.
17. Cook MB, Greenwood DC, Hardie LJ,et al. A systematic
review and meta-analysis of the risk of increasing adiposity on
Barrett’s esophagus. Am J Gastroenterol. 2008 Feb;103(2):292-
300.
18. Reid BJ, Sanchez CA, Blount PL, et al. Barrett’s esophagus: cell
cycle abnormalities in advancing stages of neoplastic
progression. Gastroenterology. 1993 Jul;105(1):119-29.
19. Sampliner RE. Medical treatment of Barrett’s esophagus: can
it prevent cancer? Surg Oncol Clin N Am. 2009 Jul;18(3):503-
8.
20. El-Serag HB, Aguirre TV, Davis S, et al. Proton pump inhibitors
are associated with reduced incidence of dysplasia in Barrett’
s esophagus. Am J Gastroenterol. 2004 Oct;99(10):1877-83.
21. Hillman LC, Chiragakis L, Shadbolt B, et al. Proton-pump
inhibitor therapy and the development of dysplasia in patients
with Barrett’s oesophagus. Med J Aust 2004 Apr 19;180(8):387-
91.
22. Chang EY, Morris CD, Seltman AK, et al. The effect of antireflux
surgery on esophageal carcinogenesis in patients with barrett
esophagus: a systematic review. Ann Surg 2007 Jul;246(1):11-
21.
23. Wassenaar EB, Oelschlager BK. Effect of medical and surgical
treatment of Barrett’s metaplasia. World J Gastroentero 2010
Aug 14;16(30):3773-9.
24. Galmiche JP, Hatlebakk J, Attwood S, et al; LOTUS Trial
Collaborators. Laparoscopic antireflux surgery vs
esomeprazole treatment for chronic GERD: the LOTUS
randomized clinical trial. JAMA 2011 May 18;305(19):1969-77.
25. Spechler SJ, Sharma P, Souza RF, et al; American
Gastroenterological Association. American Gastroenterological
Association technical review on the management of
Barrett’s esophagus. Gastroenterology 2011 Mar;140(3):e18-
52; quiz e13. doi: 10.1053/j.gastro.2011.01.031.
26. Hirota WK, Zuckerman MJ, Adler DG, et al; Standards of
Practice Committee, American Society for Gastrointestinal
Endoscopy. ASGE guideline: the role of endoscopy in the
surveillance of premalignant conditions of the upper GI tract
Gastrointest Endosc 2006 Apr;63(4):570-80.
27. Playford RJ. New British Society of Gastroenterology (BSG)
guidelines for the diagnosis and management of Barrett’s
oesophagus. Gut 2006 Apr;55(4):442.
28. Desai TK, Krishnan K, Samala N, et al. The incidence of
oesophageal adenocarcinoma in non-dysplastic Barrett’s
oesophagus: a meta-analysis. Gut 2012 Jul;61(7):970-6.
29. Wani S, Puli SR, Shaheen NJ, et al. Esophageal
adenocarcinoma in Barrett’s esophagus after endoscopic
ablative therapy: a meta-analysis and systematic review. Am
J Gastroenterol 2009 Feb;104(2):502-13.
30. Rastogi A, Puli S, El-Serag HB, et al. Incidence of esophageal
adenocarcinoma in patients with Barrett’s esophagus and
high-grade dysplasia: a meta-analysis. Gastrointest Endosc
2008 Mar;67(3):394-8.
31. Kariv R, Plesec TP, Goldblum JR, et al. The Seattle protocol
does not more reliably predict the detection of cancer at the
time of esophagectomy than a less intensive surveillance
protocol. Clin Gastroenterol Hepatol 2009 Jun;7(6):653-8.
32. Spechler SJ, Davila R. Endoscopic therapy in Barrett’s
esophagus: when and how? Surg Oncol Clin N Am 2009
Jul;18(3):509-21.
33. Rice TW. Pro: esophagectomy is the treatment of choice for
high-grade dysplasia in Barrett’s esophagus. Am J
Gastroenterol 2006 Oct;101(10):2177-9.
34. Reid BJ, Levine DS, Longton G, et al. Predictors of progression
to cancer in Barrett’s esophagus: baseline histology and flow
cytometry identify low- and high-risk patient subsets. Am J
Gastroenterol 2000 Jul;95(7):1669-76.
35. Buttar NS, Wang KK, Sebo TJ, et al. Extent of high-grade
dysplasia in Barrett’s esophagus correlates with risk of
adenocarcinoma. Gastroenterology 2001 Jun;120(7):1630-9.
36. Rice TW, Zuccaro G Jr, Adelstein DJ, et al. Esophageal
carcinoma: depth of tumor invasion is predictive of regional
lymph node status. Ann Thorac Surg 1998 Mar;65(3):787-92.
37. Rice TW, Blackstone EH, Adelstein DJ, et al. Role of clinically
determined depth of tumor invasion in the treatment of
esophageal carcinoma. J Thorac Cardiovasc Surg 2003
May;125(5):1091-102.
38. Sunpaweravong S, Chewatanakornkul S, Ruangsin S. Initial
experience and result of thoracoscopic and laparoscopic
esophagectomy. J Med Assoc Thai 2008 Aug;91(8):1202-5.
39. Westerterp M, Koppert LB, Buskens CJ, et al. Outcome of
surgical treatment for early adenocarcinoma of the
esophagus or gastro-esophageal junction. Virchows Arch
2005 May;446(5):497-504.
40. Gilbert S, Jobe BA. Surgical therapy for Barrett’s esophagus
with high-grade dysplasia and early esophageal carcinoma.
Surg Oncol Clin N Am 2009 Jul;18(3):523-31.
esophagus development. Surg Oncol Clin N Am 2009
Jul;18(3):393-410.
2. Nelsen EM, Hawes RH, Iyer PG. Diagnosis and management
of Barrett’s esophagus. Surg Clin North Am 2012 Oct;92(5):
1135-54.
3. Eisen GM, Sandler RS, Murray S, et al. The relationship between
gastroesophageal reflux disease and its complications with
Barrett’s esophagus. Am J Gastroenterol 1997 Jan;92(1):27-
31.
4. Eloubeidi MA, Provenzale D. Clinical and demographic
predictors of Barrett’s esophagus among patients with
gastroesophageal reflux disease: a multivariable analysis in
veterans. J Clin Gastroenterol. 2001 Oct;33(4):306-9.
5. Song S, Guha S, Liu K, et al. COX-2 induction by unconjugated
bile acids involves reactive oxygen species-mediated signaling
pathways in Barrett’s oesophagus and oesophageal
adenocarcinoma. Gut 2007 Nov;56(11):1512-21. Epub 2007
Jun 29.
6. Cook MB, Greenwood DC, Hardie LJ, et al. A systematic
review and meta-analysis of the risk of increasing adiposity on
Barrett’s esophagus. Am J Gastroenterol 2008 Feb;103(2):292-
300.
7. Pandolfino JE, Zhang QG, Ghosh SK, et al. Transient lower
esophageal sphincter relaxations and reflux: mechanistic
analysis using concurrent fluoroscopy and high-resolution
manometry. Gastroenterology 2006 Dec;131(6):1725-33.
8. Chak A, Falk G, Grady WM, et al. Assessment of familiality,
obesity, and other risk factors for early age of cancer diagnosis
in adenocarcinomas of the esophagus and gastroesophageal
junction. Am J Gastroenterol. 2009 Aug;104(8):1913-21.
9. Steffen A, Schulze MB, Pischon T, et al. Anthropometry and
esophageal cancer risk in the European prospective
investigation into cancer and nutrition. Cancer Epidemiol
Biomarkers Prev. 2009 Jul;18(7):2079-89.
10. Corley DA, Kubo A, Zhao W. Abdominal obesity and the risk
of esophageal and gastric cardia carcinomas. Cancer
Epidemiol Biomarkers Prev 2008 Feb;17(2):352-8.
11. Chak A, Lee T, Kinnard MF, et al. Familial aggregation of
Barrett’s oesophagus, oesophageal adenocarcinoma, and
oesophagogastric junctional adenocarcinoma in Caucasian
adults. Gut 2002 Sep;51(3):323-8.
12. Chak A, Ochs-Balcom H, Falk G, et al. Familiality in Barrett’s
esophagus, adenocarcinoma of the esophagus, and
adenocarcinoma of the gastroesophageal junction. Cancer
Epidemiol Biomarkers Prev 2006 Sep;15(9):1668-73.
13. Chak A, Chen Y, Vengoechea J, et al. Variation in age at
cancer diagnosis in familial versus nonfamilial Barrett’s
esophagus. Cancer Epidemiol Biomarkers Prev 2012
Feb;21(2):376-83.
14. Sun X, Elston R, Barnholtz-Sloan J, et al. A segregation analysis
of Barrett’s esophagus and associated adenocarcinomas.
Cancer Epidemiol Biomarkers Prev 2010 Mar;19(3):666-74.
15. Wang KK, Sampliner RE; Practice Parameters Committee of
the American College of Gastroenterology. Updated
guidelines 2008 for the diagnosis, surveillance and therapy of
Barrett’s esophagus. Am J Gastroenterol 2008 Mar;103(3):
788-97.
16. Eloubeidi MA, Provenzale D. Does this patient have Barrett’s
esophagus? The utility of predicting Barrett’s esophagus at
the index endoscopy. Am J Gastroenterol 1999 Apr;94(4):937-
43.
17. Cook MB, Greenwood DC, Hardie LJ,et al. A systematic
review and meta-analysis of the risk of increasing adiposity on
Barrett’s esophagus. Am J Gastroenterol. 2008 Feb;103(2):292-
300.
18. Reid BJ, Sanchez CA, Blount PL, et al. Barrett’s esophagus: cell
cycle abnormalities in advancing stages of neoplastic
progression. Gastroenterology. 1993 Jul;105(1):119-29.
19. Sampliner RE. Medical treatment of Barrett’s esophagus: can
it prevent cancer? Surg Oncol Clin N Am. 2009 Jul;18(3):503-
8.
20. El-Serag HB, Aguirre TV, Davis S, et al. Proton pump inhibitors
are associated with reduced incidence of dysplasia in Barrett’
s esophagus. Am J Gastroenterol. 2004 Oct;99(10):1877-83.
21. Hillman LC, Chiragakis L, Shadbolt B, et al. Proton-pump
inhibitor therapy and the development of dysplasia in patients
with Barrett’s oesophagus. Med J Aust 2004 Apr 19;180(8):387-
91.
22. Chang EY, Morris CD, Seltman AK, et al. The effect of antireflux
surgery on esophageal carcinogenesis in patients with barrett
esophagus: a systematic review. Ann Surg 2007 Jul;246(1):11-
21.
23. Wassenaar EB, Oelschlager BK. Effect of medical and surgical
treatment of Barrett’s metaplasia. World J Gastroentero 2010
Aug 14;16(30):3773-9.
24. Galmiche JP, Hatlebakk J, Attwood S, et al; LOTUS Trial
Collaborators. Laparoscopic antireflux surgery vs
esomeprazole treatment for chronic GERD: the LOTUS
randomized clinical trial. JAMA 2011 May 18;305(19):1969-77.
25. Spechler SJ, Sharma P, Souza RF, et al; American
Gastroenterological Association. American Gastroenterological
Association technical review on the management of
Barrett’s esophagus. Gastroenterology 2011 Mar;140(3):e18-
52; quiz e13. doi: 10.1053/j.gastro.2011.01.031.
26. Hirota WK, Zuckerman MJ, Adler DG, et al; Standards of
Practice Committee, American Society for Gastrointestinal
Endoscopy. ASGE guideline: the role of endoscopy in the
surveillance of premalignant conditions of the upper GI tract
Gastrointest Endosc 2006 Apr;63(4):570-80.
27. Playford RJ. New British Society of Gastroenterology (BSG)
guidelines for the diagnosis and management of Barrett’s
oesophagus. Gut 2006 Apr;55(4):442.
28. Desai TK, Krishnan K, Samala N, et al. The incidence of
oesophageal adenocarcinoma in non-dysplastic Barrett’s
oesophagus: a meta-analysis. Gut 2012 Jul;61(7):970-6.
29. Wani S, Puli SR, Shaheen NJ, et al. Esophageal
adenocarcinoma in Barrett’s esophagus after endoscopic
ablative therapy: a meta-analysis and systematic review. Am
J Gastroenterol 2009 Feb;104(2):502-13.
30. Rastogi A, Puli S, El-Serag HB, et al. Incidence of esophageal
adenocarcinoma in patients with Barrett’s esophagus and
high-grade dysplasia: a meta-analysis. Gastrointest Endosc
2008 Mar;67(3):394-8.
31. Kariv R, Plesec TP, Goldblum JR, et al. The Seattle protocol
does not more reliably predict the detection of cancer at the
time of esophagectomy than a less intensive surveillance
protocol. Clin Gastroenterol Hepatol 2009 Jun;7(6):653-8.
32. Spechler SJ, Davila R. Endoscopic therapy in Barrett’s
esophagus: when and how? Surg Oncol Clin N Am 2009
Jul;18(3):509-21.
33. Rice TW. Pro: esophagectomy is the treatment of choice for
high-grade dysplasia in Barrett’s esophagus. Am J
Gastroenterol 2006 Oct;101(10):2177-9.
34. Reid BJ, Levine DS, Longton G, et al. Predictors of progression
to cancer in Barrett’s esophagus: baseline histology and flow
cytometry identify low- and high-risk patient subsets. Am J
Gastroenterol 2000 Jul;95(7):1669-76.
35. Buttar NS, Wang KK, Sebo TJ, et al. Extent of high-grade
dysplasia in Barrett’s esophagus correlates with risk of
adenocarcinoma. Gastroenterology 2001 Jun;120(7):1630-9.
36. Rice TW, Zuccaro G Jr, Adelstein DJ, et al. Esophageal
carcinoma: depth of tumor invasion is predictive of regional
lymph node status. Ann Thorac Surg 1998 Mar;65(3):787-92.
37. Rice TW, Blackstone EH, Adelstein DJ, et al. Role of clinically
determined depth of tumor invasion in the treatment of
esophageal carcinoma. J Thorac Cardiovasc Surg 2003
May;125(5):1091-102.
38. Sunpaweravong S, Chewatanakornkul S, Ruangsin S. Initial
experience and result of thoracoscopic and laparoscopic
esophagectomy. J Med Assoc Thai 2008 Aug;91(8):1202-5.
39. Westerterp M, Koppert LB, Buskens CJ, et al. Outcome of
surgical treatment for early adenocarcinoma of the
esophagus or gastro-esophageal junction. Virchows Arch
2005 May;446(5):497-504.
40. Gilbert S, Jobe BA. Surgical therapy for Barrett’s esophagus
with high-grade dysplasia and early esophageal carcinoma.
Surg Oncol Clin N Am 2009 Jul;18(3):523-31.
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Published
2014-09-30
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1.
Sunpaweravong S. Management of Barrett’s Esophagus. Thai J Surg [Internet]. 2014 Sep. 30 [cited 2024 Apr. 25];35(3). Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/226598
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