Management of Barrett's esophagus: a narrative review

Objective: This review will aim to detail and discuss the most relevant data and current guidelines regarding Barrett's esophagus (BE), including its diagnostic and management strategies. Background: BE is a premalignant condition of esophageal adenocarcinoma (EAC) that arises due to longstanding acid-biliary reflux disease. It is believed to largely progress in a stepwise fashion from nondysplastic disease to low-grade dysplasia (LGD) then to high-grade dysplasia (HGD) and finally to EAC, which has experienced a six-fold increase in incidence over the last three decades. To address this growing public health issue, numerous rapidly evolving techniques and technologies have been developed in the areas of screening, diagnostics, surveillance, and therapeutics. Methods: A PubMed literature search along with a thorough review and cross referencing of relevant society guidelines was conducted to produce this review. Conclusions: In this comprehensive review, the latest consensus guidelines, expert opinion, widely used technologies and high impact research related to the management of BE are discussed. Screening for BE is a somewhat controversial topic, but it is generally recommended in select at-risk populations. Diagnosis is traditionally made via upper endoscopy with biopsies per the Seattle protocol. Once a diagnosis is obtained, surveillance is performed at various intervals, depending on presence and grade of dysplasia. Endoscopic eradication therapy (EET) is the mainstay for treatment of BE, consisting of mucosal resection for nodularity and ablation for dysplastic disease. As technologies for management of BE emerge, physicians' abilities to effectively diagnose and treat BE will continue to improve.