Dysplastic Barrett’s Esophagus: Surveillance, Treatment and Follow-Up Care

Abstract

Gastroesophageal reflux disease (GERD) is important due to its recurrence, being the main reason for consultations and with a prevalence of over 25% in Asia and Southeast Europe. The most feared complication of GERD is esophageal adenocarcinoma (EAC), preceded by Barrett's esophagus (BE). However, the epidemiology of this disease remains unknown due to the low specificity of the symptoms and the lack of consensus on the endoscopic characteristics for its diagnosis. In dysplastic forms of BE, which are more likely to progress to EAC, there has been little research into the best management of dysplastic BE. OBJECTIVE: to clarify controversies about the management of dysplastic BE. METHOD: a systematic horizontal review, PRISMA method through electronic search in PubMed, between 2018 and 2022, with descriptors: "Barrett's Esophagus" and "Surveillance AND dysplasia AND esophagus" for all age groups. Inclusion: articles in English, with compatible titles and abstracts. We obtained 620 results and after selection 17 articles were included. RESULTS: 13 articles indicate SeattleProtocol for diagnosis and surveillance; 5, anti-reflux therapy before endoscopy and 12, confirmation of dysplasia by a specialized pathologist. Low-grade dysplasia (LGD) follow-up: endoscopic eradication therapy (EET) and surveillance are equally acceptable in 6 articles, there is a preference for EET in 5 and surveillance in 1. High-grade dysplasia (HGD) follow-up: endoscopic therapies recommended in 12 articles. Follow-up after dysplastic eradication: periodic and continuous endoscopic surveillance indicated in 9 articles and treatment with proton pump inhibitors in 2 articles. DISCUSSION: Although Seattle Protocol is recommended for surveillance, it covers a small part of the esophageal mucosa, in addition to being time-consuming and having low adherence.There are still controversies about the management of LGD but, in general, ablation is advocated to the detriment of surveillance. There is consensus on endoscopic ablation therapy until complete eradication of HGD. Esophagectomy is not recommended. After eradication, continued surveillance and proton pump inhibitors. CONCLUSION: Disagreements persist due to discrepancies between studies, especially in low-grade dysplastic BE.