Diagnosis and Management of Barrett’s Metaplasia
Barrett’s metaplasia (BM) is a common pre-malignant condition with unknown population prevalence, but an increasing endoscopic incidence. BM develops in the context of gastro-oesophageal reflux and is a major risk factor for oesophageal adenocarcinoma, which develops from BM via a metaplasia–dysplasia–carcinoma pathway. Current treatment strategies aim to prevent the progression through this pathway with drug regimes and detect dysplasia early via endoscopic surveillance. Multiple imaging modalities and adjuncts have been employed to detect dysplastic epithelium in BM, including high-definition endoscopy, confocal endomicroscopy, narrow band imaging, chromoendoscopy and autofluorescence. Historically, oesophagectomy was the only potentially curative treatment option for oesophageal adenocarcinoma in the context of BM, but the last 10 years have seen a dramatic increase in the use of endoscopic resection and ablation technologies. Endoscopic mucosal resection, photodynamic therapy and radiofrequency ablation can be considered for treatment of high-grade dysplasia and early oesophageal adenocarcinoma.
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