research
Barrett Esophagus: Improving Surveillance Strategies
- Publication date
- 14 June 2007
- Publisher
- The aim of surveillance in patients with a Barrett esophagus (BE) is to detect progression of dysplasia
at an early and therefore likely curable stage. The interval of endoscopic surveillance in patients
with BE is currently based on the histopathological stage (i.e. grade of dysplasia). This approach
is however known to have several pitfalls. First, only patients with intestinal metaplasia (IM) in the
columnar-lined segment of the esophagus (CLE) have so far been regarded to have a premalignant
condition and are enrolled in an endoscopic surveillance program, in contrast to patients with only
cardiac-type mucosa (CM) in their biopsies. However, as IM and CM can be both present in the
CLE and are endoscopically indiscernible, sampling error can occur, and exclusion of patients with
only CM from endoscopic follow-up might therefore be incorrect. In addition, it has been suggested
that IM in CLE may develop over time, and a follow-up endoscopy in the course of time may
than detect IM. Secondly, in line with the risk of neoplastic progression, the presence or absence
of dysplasia in IM determines the frequency of endoscopic surveillance, but the interpretation of
dysplasia is subject to considerable interobserver variability, leading to both superfl uous follow-up
endoscopies in some patients and insuffi cient control of others. Therefore, it is relevant to perform
risk stratifi cation to defi ne which subgroup of patients with CLE with or without IM should undergo
endoscopic follow-up, and at which frequency.
The aim of the work described in this thesis was to assess the currently used criteria for performing
endoscopic surveillance in patients with CLE, and to evaluate which clinical characteristics and
biomarkers could contribute to risk stratifi cation in patients with CLE, in order to refi ne surveillance
strategies in these patients.