Columnar lined (Barrett's) esophagus: Future perspectives

Abstract

Columnar lined esophagus (CLE) or Barrett's esophagus is the precursor for esophageal adenocarcinoma. Future advances in understanding and management of this condition as well as improving the quality of care of CLE patients depends on answering essential questions. It is important to standardize the criteria for CLE definition. The rapid increase in incidence of CLE and adenocarcinoma raises serious concerns that the current management of gastroesophageal reflux disease (GERD) needs reassessment. The risk factors that determine who will and will not develop CLE are as yet undetermined. There is a need to develop a clinical risk stratification tool, which will help in determining who should be screened. The impact of elimination of GERD on the natural history of CLE is one important area for future research. The benefit of surveillance strategies remains unproven and the ideal endoscopic frequency, protocols and markers of cancer risk are unknown. Dysplasia may not provide the gold standard marker of cancer risk because of some inherited problems. A better technique than the current endoscopic pinch biopsy protocol is needed. To overcome the limitations of histological markers, many other markers of cancer risk needs to be developed and validated. The key question as to whether cancer risk is actually reduced by the new ablation modalities remains unanswered. The natural history of dysplasia and its management needs to be clarified. Although many questions have to be answered, it seems, however, that at least some answers exist, and these and proposals for answering some of these questions are underlined throughout this review.

Biomedical Applications of Raman Imaging

“…Patients with low-grade dysphasia (LGD) are advised to undergo routine endoscopic biopsy surveillance, whereas patients with high-grade dysphasia (HGD) may require more intensive surveillance with surgical resection or endoscopic ablation [38]. The benefits of using such surveillance approaches, however, still remain unproven, owing to the problem with interobserver variability and inadequately defined markers of dysplasia and early carcinogenesis [39][40][41][42]. Several emerging optical diagnostic techniques are currently been investigated and in some cases validated against gold standard histopathological approaches to address some of these issues [43][44][45][46].…”

Columnar‐lined esophagus: Time to drop the eponym of “Barrett”: Historical review

“…During the refined research stage, numerous studies have investigated the use of electron microscopy, enzyme assays, flow cytometry, molecular biology and many new endoscopic technologies to increase our understanding of this condition. This stage has also included the search for suitable clinical, 33 histological and biological markers 34 to detect malignant progression of the columnar epithelium, and it has also witnessed the evolution of many therapeutic techniques including ablation therapy to deal with the treatment of this increasing problem 35 . Despite these enormous developments, many important aspects regarding CLE have remained unsettled until now.…”

Role of CD1A and HSP60 in the antitumoral response of oesophageal cancer

“…These events can in turn lead to carcinogenesis [4]. When the normal squamous epithelium of the oesophagus is replaced by a metaplastic columnar epithelium, a histological lesion known as Barrett's metaplasia (BM) occurs [1, 5,6]. Under the stimulation of growth factors this tissue might possibly proliferate to recover its original state.…”