Abstract
Barrett's esophagus (BE), a premalignant condition for esophageal adenocarcinoma, is a common lesion in the Western world, and a problem increasingly seen in Asia. This condition, which is thought to be caused by chronic gastroesophageal reflux (GERD) in the genetically susceptible host, occurs in approximately 2 % of adults in the U.S. and Europe. The incidence of esophageal adenocarcinoma has risen dramatically in Western countries in the past 40 years, with a >500 % increase since the 1970's. Our current approach to BE is to perform endoscopic screening of patients with chronic GERD, and then to perform intermittent endoscopic surveillance of GERD patients found to have BE. If, during these surveillance endoscopies, biopsies demonstrate dysplasia within the BE, the patient becomes a candidate for endoscopic ablative therapy. The current most commonly used form of ablative therapy is radiofrequency ablation (RFA). If there is nodularity within the BE segment, the patient may require endoscopic mucosal resection, or endoscopic submucosal dissection, prior to the RFA. This approach is associated with success rates of 80-95 %, and patients with high-grade dysplasia and even intramucosal carcinoma are highly likely to have eradication of their lesion without the need for surgical esophagectomy. Although these advances are reason for hope, the epidemiological trends of esophageal adenocarcinoma remain unfavorable, with a still-increasing incidence rate. A major reason for the increasing incidence of esophageal adenocarcinoma is that most patients who will develop the cancer never know that they have BE prior to the development of the cancer. Therefore, they are not eligible for endoscopic screening and surveillance programs, and are unlikely to have early treatment of mucosal cancer. Instead, they present with symptoms of dysphagia, which are generally associated with advanced stage and incurable cancer. Therefore, the next great target for advancement of care in this disease is more accurate, cheaper, and widespread screening. Several devices have been proposed to allow larger scale and cheaper screening of patients for BE. These devices will be reviewed in this lecture.