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Gut 63:191-202 doi:10.1136/gutjnl-2013-305490
  • Recent advances in clinical practice

Barrett's oesophagus: epidemiology, cancer risk and implications for management

  1. Ernst J Kuipers1,4
  1. 1Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
  2. 2Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
  3. 3Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
  4. 4Department of Internal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
  1. Correspondence to Dr P J F de Jonge, Erasmus MC University Medical Center Rotterdam, Department of Gastroenterology and Hepatology, Postbox 2040, Rotterdam 3000 CA, The Netherlands; p.dejonge{at}erasmusmc.nl
  • Received 18 June 2013
  • Revised 5 September 2013
  • Accepted 10 September 2013
  • Published Online First 3 October 2013

Abstract

Although endoscopic surveillance of patients with Barrett's oesophagus has been widely implemented, its effectiveness is debateable. The recently reported low annual oesophageal adenocarcinoma risk in population studies, the failure to identify most Barrett's patients at risk of disease progression, the poor adherence to surveillance and biopsy protocols, and the significant risk of misclassification of dysplasia all tend to undermine the effectiveness of current management, in particular, endoscopic surveillance programmes, to prevent or improve the outcomes of patients with oesophageal adenocarcinoma. The ongoing increase in incidence of Barrett's oesophagus and consequent growth of the surveillance population, together with the associated discomfort and costs of endoscopic surveillance, demand improved techniques for accurately determining individual risk of oesophageal adenocarcinoma. More accurate techniques are needed to run efficient surveillance programmes in the coming decades. In this review, we will discuss the current knowledge on the epidemiology of Barrett's oesophagus, and the challenging epidemiological dilemmas that need to be addressed when assessing the current screening and surveillance strategies.