Barrett's esophagus: Surveillance and treatment

Barrett's esophagus is a disease of paramount importance dictated by its exponentially increasing incidence and association with esophageal cancer. Unfortunately, our knowledge lacks much of the key data and information to make those important decisions in Barrett's as regards screening and treatment. With an evident lack of long-term large population studies of patients with Barrett's esophagus, much of our decision making is based on little available data and becomes somewhat arbitrary. Given these limitations, screening criteria include adults with a long history of persistent reflux symptoms. The precise age, frequency, and duration of symptoms used is unclear. Once Barrett's is identified, endoscopic surveillance is performed every 2 years, but this interval will most likely lengthen to 3 years. For patients with LGD, surveillance every 6-12 months is recommended. For HGD, esophagectomy is still recommended for healthy surgical candidates, but more patients will be followed, particularly those with "focal" HGD. The role of acid suppression either pharmacologically or surgically is not clear, but the tendency is to achieve near complete control of the acid reflux. Endoscopic ablative procedures are experimental and may be indicated in patients at high surgical risk with HGD and carcinoma. Its role in mainstream practice is yet to be defined.