Barrett's Esophagus: How Should we Manage it?
Barrett's Esophagus: How Should we Manage it?
The recent update to BSG guidelines represents a move towards a more stratified approach to surveillance of Barrett's oesophagus. This trend is likely to continue with ongoing efforts to identify those at high risk of progression through appropriate genetic or cellular biomarkers.
Advances in endoscopic therapy have revolutionised the treatment of dysplastic Barrett's oesophagus, and this indication now extends to those with confirmed LGD, although the challenges of achieving consensus histology remain a pressing issue.
Ongoing trials of chemoprevention and screening may lead to new approaches to Barrett's oesophagus. The possibility of an efficacious, non-endoscopic test offers hope of a cost-effective means of achieving this, and large-scale randomised trial data are eagerly awaited to evaluate agents, such as aspirin and PPIs, as chemoprevention in Barrett's oesophagus.
Thus, it seems likely that the future will bring a continued increase in intervention for those with early disease through chemoprevention and endotherapy, more targeted surveillance, and a reduction in patients requiring radical surgery or presenting with disseminated disease.
Conclusions
The recent update to BSG guidelines represents a move towards a more stratified approach to surveillance of Barrett's oesophagus. This trend is likely to continue with ongoing efforts to identify those at high risk of progression through appropriate genetic or cellular biomarkers.
Advances in endoscopic therapy have revolutionised the treatment of dysplastic Barrett's oesophagus, and this indication now extends to those with confirmed LGD, although the challenges of achieving consensus histology remain a pressing issue.
Ongoing trials of chemoprevention and screening may lead to new approaches to Barrett's oesophagus. The possibility of an efficacious, non-endoscopic test offers hope of a cost-effective means of achieving this, and large-scale randomised trial data are eagerly awaited to evaluate agents, such as aspirin and PPIs, as chemoprevention in Barrett's oesophagus.
Thus, it seems likely that the future will bring a continued increase in intervention for those with early disease through chemoprevention and endotherapy, more targeted surveillance, and a reduction in patients requiring radical surgery or presenting with disseminated disease.
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