Optimal management of Barrett&#39;s esophagus: pharmacologic, endoscopic, and surgical interventions

Vani JA Konda1, Kunal Dalal21Section of Gastroenterology, Department of Medicine, 2Department of Internal Medicine, University of Chicago Medical Center, Chicago, Illinois, USAAbstract: Esophageal adenocarcinoma and its precursor, Barrett&#39;s esophagus, are rapidly rising in incidence. Thi...

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Autores principales:	Konda VJA, Dalal K
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2011
Materias:	Therapeutics. Pharmacology RM1-950
Acceso en línea:	https://doaj.org/article/52a1010e982a4b9a8b854e0206b64462
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spelling	oai:doaj.org-article:52a1010e982a4b9a8b854e0206b644622021-12-02T11:43:20ZOptimal management of Barrett&#39;s esophagus: pharmacologic, endoscopic, and surgical interventions1176-63361178-203Xhttps://doaj.org/article/52a1010e982a4b9a8b854e0206b644622011-11-01T00:00:00Zhttp://www.dovepress.com/optimal-management-of-barrett39s-esophagus-pharmacologic-endoscopic-an-a8714https://doaj.org/toc/1176-6336https://doaj.org/toc/1178-203XVani JA Konda1, Kunal Dalal21Section of Gastroenterology, Department of Medicine, 2Department of Internal Medicine, University of Chicago Medical Center, Chicago, Illinois, USAAbstract: Esophageal adenocarcinoma and its precursor, Barrett&#39;s esophagus, are rapidly rising in incidence. This review serves to highlight the role of pharmacologic, endoscopic, and surgical intervention in the management of Barrett&#39;s esophagus, which requires acid suppression and endoscopic assessment. Treatment with a proton pump inhibitor may decrease acid exposure and delay the progression to dysplasia. Patients who require aspirin for cardioprotection or other indications may also benefit in terms of a protective effect against the development of esophageal cancer. However, without other indications, aspirin is not indicated solely to prevent cancer. A careful endoscopic examination should include assessment of any visible lesions in a Barrett&#39;s segment. An expert gastrointestinal pathologist should confirm neoplasia in the setting of Barrett&#39;s esophagus. For those patients with high-grade dysplasia or intramucosal carcinoma, careful consideration of endoscopic therapy or surgical therapy must be given. All visible lesions in the setting of dysplasia should be targeted with focal endoscopic mucosal resection for both accurate histopathologic diagnosis and treatment. The remainder of the Barrett&#39;s epithelium should be eradicated to address all synchronous and metachronous lesions. This may be done by tissue acquiring or nontissue acquiring means. Radiofrequency ablation has a positive benefit-risk profile for flat Barrett&#39;s esophagus. At this time, endoscopic therapy is not indicated for nondysplastic Barrett&#39;s esophagus. Esophagectomy is still reserved for selected cases with evidence of lymph node metastasis, unsuccessful endoscopic therapy, or with high-risk features of high-grade dysplasia or intramucosal carcinoma.Keywords: Barrett&#39;s esophagus, high-grade dysplasia, esophagectomy, ablation, endoscopic mucosal resectionKonda VJADalal KDove Medical PressarticleTherapeutics. PharmacologyRM1-950ENTherapeutics and Clinical Risk Management, Vol 2011, Iss default, Pp 447-458 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	Therapeutics. Pharmacology RM1-950
spellingShingle	Therapeutics. Pharmacology RM1-950 Konda VJA Dalal K Optimal management of Barrett&#39;s esophagus: pharmacologic, endoscopic, and surgical interventions
description	Vani JA Konda1, Kunal Dalal21Section of Gastroenterology, Department of Medicine, 2Department of Internal Medicine, University of Chicago Medical Center, Chicago, Illinois, USAAbstract: Esophageal adenocarcinoma and its precursor, Barrett&#39;s esophagus, are rapidly rising in incidence. This review serves to highlight the role of pharmacologic, endoscopic, and surgical intervention in the management of Barrett&#39;s esophagus, which requires acid suppression and endoscopic assessment. Treatment with a proton pump inhibitor may decrease acid exposure and delay the progression to dysplasia. Patients who require aspirin for cardioprotection or other indications may also benefit in terms of a protective effect against the development of esophageal cancer. However, without other indications, aspirin is not indicated solely to prevent cancer. A careful endoscopic examination should include assessment of any visible lesions in a Barrett&#39;s segment. An expert gastrointestinal pathologist should confirm neoplasia in the setting of Barrett&#39;s esophagus. For those patients with high-grade dysplasia or intramucosal carcinoma, careful consideration of endoscopic therapy or surgical therapy must be given. All visible lesions in the setting of dysplasia should be targeted with focal endoscopic mucosal resection for both accurate histopathologic diagnosis and treatment. The remainder of the Barrett&#39;s epithelium should be eradicated to address all synchronous and metachronous lesions. This may be done by tissue acquiring or nontissue acquiring means. Radiofrequency ablation has a positive benefit-risk profile for flat Barrett&#39;s esophagus. At this time, endoscopic therapy is not indicated for nondysplastic Barrett&#39;s esophagus. Esophagectomy is still reserved for selected cases with evidence of lymph node metastasis, unsuccessful endoscopic therapy, or with high-risk features of high-grade dysplasia or intramucosal carcinoma.Keywords: Barrett&#39;s esophagus, high-grade dysplasia, esophagectomy, ablation, endoscopic mucosal resection
format	article
author	Konda VJA Dalal K
author_facet	Konda VJA Dalal K
author_sort	Konda VJA
title	Optimal management of Barrett&#39;s esophagus: pharmacologic, endoscopic, and surgical interventions
title_short	Optimal management of Barrett&#39;s esophagus: pharmacologic, endoscopic, and surgical interventions
title_full	Optimal management of Barrett&#39;s esophagus: pharmacologic, endoscopic, and surgical interventions
title_fullStr	Optimal management of Barrett&#39;s esophagus: pharmacologic, endoscopic, and surgical interventions
title_full_unstemmed	Optimal management of Barrett&#39;s esophagus: pharmacologic, endoscopic, and surgical interventions
title_sort	optimal management of barrett&#39;s esophagus: pharmacologic, endoscopic, and surgical interventions
publisher	Dove Medical Press
publishDate	2011
url	https://doaj.org/article/52a1010e982a4b9a8b854e0206b64462
work_keys_str_mv	AT kondavja optimalmanagementofbarrettamp39sesophaguspharmacologicendoscopicandsurgicalinterventions AT dalalk optimalmanagementofbarrettamp39sesophaguspharmacologicendoscopicandsurgicalinterventions
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Optimal management of Barrett&amp;#39;s esophagus: pharmacologic, endoscopic, and surgical interventions

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Optimal management of Barrett's esophagus: pharmacologic, endoscopic, and surgical interventions