Endoscopic Treatment for Barrett’s Esophagus and Early Esophageal Cancer

Excerpt

Barrett’s esophagus offers two unique opportunities to endoscopically study neoplasia in the esophagus. The first is the effect of chronic inflammatory change produced by reflux of acid and bile into the distal esophagus, producing a partially intestinalized metaplastic epithelium. Most endoscopic therapies for neoplasia do not address this issue since the significance of this process in neoplastic progression is unclear. The pre-neoplastic condition though allows investigators the opportunity to examine the pathogenesis of metaplasia and to assess potential biomarkers. The second opportunity is the ability to treat the metaplasia producing normal appearing squamous mucosa using endoscopic therapies. These techniques have been adapted from the strategies developed from squamous cancers of the esophagus. However, the apparent reversal of the metaplastic process is unique to Barrett’s esophagus. The epidemiology of this disease suggests that it is rapidly increasing in Western populations and may be increasing in Asian countries as well. …