The future of therapy of Barrett’s esophagus and related cancer: a narrative review

Abstract

: Barrett’s esophagus (BE) is an intestinal-type metaplastic condition of the esophagus, which occurs in response to severe inflammation generally as result of chronic gastro-esophageal reflux. Over the last 5 decades, since the link between BE and esophageal adenocarcinoma (EAC) has been established, endoscopy has played a key role in the management of this condition, as a procedure initially to diagnose and monitor the precancerous disease and more recently also to deliver therapeutic interventions. The treatment algorithm for BE has seen dramatic changes in the last 10 years thanks to the better understanding of the natural history of dysplasia and early EAC and to the advent of effective endoscopic ablation techniques. Nevertheless, the incidence of EAC is increasing worldwide and many questions still remain to be addressed. There is growing need to combine technological advances with early diagnosis and targeted pharmacological treatments in order to refine management strategies. This would ideally entail early intervention on patients with a high probability to progress to cancer and minimally invasive treatment in patients with cancer at low metastatic risk. In this article we will discuss how improved understanding about the molecular make up of the disease and the emerging diagnostic and therapeutic technologies at the horizon can help reshape the endoscopic management of BE in the near future. 15