Barrett's Esophagus (cont.)

In an ideal world, all Barrett's esophagus, with or without dysplasia, would be ablated for life. Thereby, both Barrett's and its attendant risk of cancer would be eliminated. Experimental ablation (as described above for dysplasia) is being evaluated in Barrett's without dysplasia. However, long-term studies are needed to prove the durability of the ablation (for example, with antireflux surgery or acid-suppressing drugs).

Barrett's mucosa without dysplasia can be destroyed by using argon plasma coagulation and multipolar electrocoagulation techniques. (As already mentioned, the more powerful PDT has been used most commonly for high grade dysplasia and cancer.) To prevent recurrence of Barrett's after ablation, however, requires the elimination of reflux for life, either with high dose acid suppressing drugs or anti-reflux surgery (fundoplication).

After an ablation procedure, the normal squamous lining in the esophagus grows back. Sometimes, however, after ablation therapy, the residual Barrett's mucosa remains under the new lining. The outcome and importance of this subterranean Barrett's is not known. It should be stressed that ablation therapy is experimental and should be restricted to formal studies.

Most of the future developments in the field of Barrett's esophagus will depend on the results of research studies. The goals of such studies would be to:

• Standardize the diagnosis of Barrett's, especially to avoid over-diagnosis.
  
  
• Standardize how surveillance biopsies are done so that we can "do it right and do it less often," and devote more resources to the next step, which is screening.
  
  
• Develop strategies for determining whom to screen and when to screen for the presence of Barrett's esophagus among patients with chronic GERD. At present, most GERD patients with adenocarcinoma of the esophagus have never had an endoscopy to determine whether they had Barrett's esophagus.
  
  
• Look for biomarkers (molecular tests on tissues or in blood) that are able to separate (stratify) patients with the highest risk of cancer in those who would need closer follow-up than the majority of Barrett's patients who do not.
  
  
• Evaluate the effectiveness and safety of the techniques for ablation and endoscopic mucosal resection (EMR) of Barrett's with and without dysplasia, and carry out long term follow-up studies to determine whether cancer is prevented.
  
  
• Evaluate better techniques for targeting biopsies to areas of dysplasia in order to avoid the currently used method of taking random biopsies.
  
  
• Evaluate better techniques for staging early cancer with refinements of endoscopic ultrasound and other imaging techniques.

Source: MedicineNet.com
http://www.medicinenet.com/barretts_esophagus/article.htm