Abstract
Many developments have been made in the field of Barrett esophagus that have tremendous clinical implications. There are new definitions of Barrett esophagus that have had an immediate clinical impact on cancer risk and screening. Of interest is the definition by the British Society of Gastroenterology, which does not require the presence of intestinal metaplasia for a diagnosis of Barrett esophagus. Imaging techniques that allow improved visualization of intestinal metaplasia at the cellular level are now being used in clinical practice. New hypotheses elucidating the progression from squamous epithelium to intestinal metaplasia have been proposed. Indeed, the crucial role that transcription factors have in the pathogenesis of Barrett esophagus has been clarified. Improved characterization of the molecular mechanisms underlying Barrett esophagus is an incentive to undertake more basic science research in this field. Such research could also help with the development of chemoprevention strategies for this precancerous condition. This Review discusses the advances in understanding of the pathogenesis, diagnosis and treatment of Barrett esophagus.
Key Points
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The field of Barrett esophagus is evolving, with advances in understanding of the pathogenesis, diagnosis and treatment of this premalignant condition
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In the USA, the presence of both salmon-colored mucosa on upper endoscopy and specialized intestinal metaplasia in biopsy specimens is required to diagnose Barrett esophagus
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New concepts regarding the pathogenesis of Barrett esophagus have been elucidated; CDX2 and BMP4 are thought to have a key role in the pathogenesis of this condition
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New imaging techniques, such as narrow band imaging and confocal laser microscopy, are helping in the diagnosis of Barrett esophagus
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Ablative techniques, including radiofrequency ablation, are becoming increasingly accepted treatments for Barrett esophagus given their low complication rate and high eradication rate
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References
Wang, K. K. & Sampliner, R. E. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus. Am. J. Gastroenterol. 103, 788–797 (2008).
Playford, R. J. New British Society of Gastroenterology (BSG) guidelines for the diagnosis and management of Barrett's oesophagus. Gut 55, 442 (2006).
Kerkhof, M., Steyerberg, E. W., Kusters, J. G., Kuipers, E. J. & Siersema, P. D. Predicting presence of intestinal metaplasia and dysplasia in columnar-lined esophagus: a multivariate analysis. Endoscopy 39, 772–778 (2007).
van Baal, J. W. et al. A comparative analysis by SAGE of gene expression profiles of Barrett's esophagus, normal squamous esophagus, and gastric cardia. Gastroenterology 129, 1274–1281 (2005).
Kelty, C. J., Gough, M. D., Van Wyk, Q., Stephenson, T. J. & Ackroyd, R. Barrett's oesophagus: intestinal metaplasia is not essential for cancer risk. Scand. J. Gastroenterol. 42, 1271–1274 (2007).
Sharma, P. et al. The development and validation of an endoscopic grading system for Barrett's esophagus: the Prague C & M criteria. Gastroenterology 131, 1392–1399 (2006).
Bytzer, P., Christensen, P. B., Damkier, P., Vinding, K. & Seersholm, N. Adenocarcinoma of the esophagus and Barrett's esophagus: a population-based study. Am. J. Gastroenterol. 94, 86–91 (1999).
Harrison, R. et al. Detection of intestinal metaplasia in Barrett's esophagus: an observational comparator study suggests the need for a minimum of eight biopsies. Am. J. Gastroenterol. 102, 1154–1161 (2007).
Montgomery, E. et al. Reproducibility of the diagnosis of dysplasia in Barrett esophagus: a reaffirmation. Hum. Pathol. 32, 368–378 (2001).
Odze, R. D. Barrett esophagus: histology and pathology for the clinician. Nat. Rev. Gastroenterol. Hepatol. 6, 478–490 (2009).
Eisen, G. M., Sandler, R. S., Murray, S. & Gottfried, M. The relationship between gastroesophageal reflux disease and its complications with Barrett's esophagus. Am. J. Gastroenterol. 92, 27–31 (1997).
Chiu, P. W. et al. Esophageal pH exposure and epithelial cell differentiation. Dis. Esophagus 22, 596–599 (2009).
Fletcher, J., Wirz, A., Henry, E. & McColl, K. E. Studies of acid exposure immediately above the gastro-oesophageal squamocolumnar junction: evidence of short segment reflux. Gut 53, 168–173 (2004).
Farre, R. et al. Critical role of stress in increased oesophageal mucosa permeability and dilated intercellular spaces. Gut 56, 1191–1197 (2007).
Jovov, B. et al. Claudin-18: a dominant tight junction protein in Barrett's esophagus and likely contributor to its acid resistance. Am. J. Physiol. Gastrointest. Liver Physiol. 293, G1106–G1113 (2007).
Fletcher, J., Wirz, A., Young, J., Vallance, R. & McColl, K. E. Unbuffered highly acidic gastric juice exists at the gastroesophageal junction after a meal. Gastroenterology 121, 775–783 (2001).
Iijima, K. et al. Dietary nitrate generates potentially mutagenic concentrations of nitric oxide at the gastroesophageal junction. Gastroenterology 122, 1248–1257 (2002).
Spechler, S. J. Review article: what I do now to manage adenocarcinoma risk, and what I may be doing in 10 years' time. Aliment. Pharmacol. Ther. 20 (Suppl. 5), 105–110 (2004).
Clemons, N. J., McColl, K. E. & Fitzgerald, R. C. Nitric oxide and acid induce double-strand DNA breaks in Barrett's esophagus carcinogenesis via distinct mechanisms. Gastroenterology 133, 1198–1209 (2007).
Chak, A. et al. Familial aggregation of Barrett's oesophagus, oesophageal adenocarcinoma, and oesophagogastric junctional adenocarcinoma in Caucasian adults. Gut 51, 323–328 (2002).
Gerson, L. B., Shetler, K. & Triadafilopoulos, G. Prevalence of Barrett's esophagus in asymptomatic individuals. Gastroenterology 123, 461–467 (2002).
Romero, Y. et al. Barrett's esophagus: prevalence in symptomatic relatives. Am. J. Gastroenterol. 97, 1127–1132 (2002).
Romero, Y. et al. Familial aggregation of gastroesophageal reflux in patients with Barrett's esophagus and esophageal adenocarcinoma. Gastroenterology 113, 1449–1456 (1997).
Trudgill, N. J., Kapur, K. C. & Riley, S. A. Familial clustering of reflux symptoms. Am. J. Gastroenterol. 94, 1172–1178 (1999).
Izzo, J. G. et al. Cyclin D1 guanine/adenine 870 polymorphism with altered protein expression is associated with genomic instability and aggressive clinical biology of esophageal adenocarcinoma. J. Clin. Oncol. 25, 698–707 (2007).
Kala, Z., Dolina, J., Marek, F. & Izakovicova Holla, L. Polymorphisms of glutathione S-transferase M1, T1 and P1 in patients with reflux esophagitis and Barrett's esophagus. J. Hum. Genet. 52, 527–534 (2007).
Murphy, S. J. et al. A population-based association study of SNPs of GSTP1, MnSOD, GPX2 and Barrett's esophagus and esophageal adenocarcinoma. Carcinogenesis 28, 1323–1328 (2007).
Payne, C. M. et al. Mitochondrial perturbation attenuates bile acid-induced cytotoxicity. Cell Biol. Toxicol. 21, 215–231 (2005).
Bernstein, H., Bernstein, C., Payne, C. M., Dvorakova, K. & Garewal, H. Bile acids as carcinogens in human gastrointestinal cancers. Mutat. Res. 589, 47–65 (2005).
Bernstein, H. et al. Activation of the promoters of genes associated with DNA damage, oxidative stress, ER stress and protein malfolding by the bile salt, deoxycholate. Toxicol. Lett. 108, 37–46 (1999).
Dvorak, K. et al. Bile acids in combination with low pH induce oxidative stress and oxidative DNA damage: relevance to the pathogenesis of Barrett's oesophagus. Gut 56, 763–771 (2007).
Dvorak, K. et al. Expression of bile acid transporting proteins in Barrett's esophagus and esophageal adenocarcinoma. Am. J. Gastroenterol. 104, 302–309 (2009).
Rokkas, T., Pistiolas, D., Sechopoulos, P., Robotis, I. & Margantinis, G. Relationship between Helicobacter pylori infection and esophageal neoplasia: a meta-analysis. Clin. Gastroenterol. Hepatol. 5, 1413–1417 (2007).
Wang, C., Yuan, Y. & Hunt, R. H. Helicobacter pylori infection and Barrett's esophagus: a systematic review and meta-analysis. Am. J. Gastroenterol. 104, 492–500 (2009).
Chow, W. H. et al. An inverse relation between cagA+ strains of Helicobacter pylori infection and risk of esophageal and gastric cardia adenocarcinoma. Cancer Res. 58, 588–590 (1998).
Wu, A. H. et al. Role of Helicobacter pylori CagA+ strains and risk of adenocarcinoma of the stomach and esophagus. Int. J. Cancer 103, 815–821 (2003).
Ye, W. et al. Helicobacter pylori infection and gastric atrophy: risk of adenocarcinoma and squamous-cell carcinoma of the esophagus and adenocarcinoma of the gastric cardia. J. Natl Cancer Inst. 96, 388–396 (2004).
Malfertheiner, P. et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 56, 772–781 (2007).
Laine, L. & Sugg, J. Effect of Helicobacter pylori eradication on development of erosive esophagitis and gastroesophageal reflux disease symptoms: a post hoc analysis of eight double blind prospective studies. Am. J. Gastroenterol. 97, 2992–2997 (2002).
Malfertheiner, P. et al. Impact of Helicobacter pylori eradication on heartburn in patients with gastric or duodenal ulcer disease—results from a randomized trial programme. Aliment. Pharmacol. Ther. 16, 1431–1442 (2002).
McColl, K. E., Dickson, A., El-Nujumi, A., El-Omar, E. & Kelman, A. Symptomatic benefit 1–3 years after H. pylori eradication in ulcer patients: impact of gastroesophageal reflux disease. Am. J. Gastroenterol. 95, 101–105 (2000).
Kuipers, E. J. et al. Cure of Helicobacter pylori infection in patients with reflux oesophagitis treated with long term omeprazole reverses gastritis without exacerbation of reflux disease: results of a randomised controlled trial. Gut 53, 12–20 (2004).
Moayyedi, P. et al. Helicobacter pylori eradication does not exacerbate reflux symptoms in gastroesophageal reflux disease. Gastroenterology 121, 1120–1126 (2001).
Abrams, J. A. Obesity and Barrett's oesophagus: more than just reflux. Gut 58, 1437–1438 (2009).
El-Serag, H. B., Kvapil, P., Hacken-Bitar, J. & Kramer, J. R. Abdominal obesity and the risk of Barrett's esophagus. Am. J. Gastroenterol. 100, 2151–2156 (2005).
Kubo, A. & Corley, D. A. Body mass index and adenocarcinomas of the esophagus or gastric cardia: a systematic review and meta-analysis. Cancer Epidemiol. Biomarkers Prev. 15, 872–878 (2006).
Lagergren, J., Bergstrom, R. & Nyren, O. Association between body mass and adenocarcinoma of the esophagus and gastric cardia. Ann. Intern. Med. 130, 883–890 (1999).
Moayyedi, P. The epidemiology of obesity and gastrointestinal and other diseases: an overview. Dig. Dis. Sci. 53, 2293–2299 (2008).
Moayyedi, P. Barrett's esophagus and obesity: the missing part of the puzzle. Am. J. Gastroenterol. 103, 301–303 (2008).
Seidel, D., Muangpaisan, W., Hiro, H., Mathew, A. & Lyratzopoulos, G. The association between body mass index and Barrett's esophagus: a systematic review. Dis. Esophagus 22, 564–570 (2009).
Corley, D. A. et al. Abdominal obesity and body mass index as risk factors for Barrett's esophagus. Gastroenterology 133, 34–41 (2007).
Edelstein, Z. R., Farrow, D. C., Bronner, M. P., Rosen, S. N. & Vaughan, T. L. Central adiposity and risk of Barrett's esophagus. Gastroenterology 133, 403–411 (2007).
Kendall, B. J. et al. Leptin and the risk of Barrett's oesophagus. Gut 57, 448–454 (2008).
Rubenstein, J. H. et al. Association of adiponectin multimers with Barrett's oesophagus. Gut 58, 1583–1589 (2009).
Milano, F. et al. Bone morphogenetic protein 4 expressed in esophagitis induces a columnar phenotype in esophageal squamous cells. Gastroenterology 132, 2412–2421 (2007).
Sarosi, G. et al. Bone marrow progenitor cells contribute to esophageal regeneration and metaplasia in a rat model of Barrett's esophagus. Dis. Esophagus 21, 43–50 (2008).
Moons, L. M. et al. A pro-inflammatory genotype predisposes to Barrett's esophagus. Carcinogenesis 29, 926–931 (2008).
Fitzgerald, R. C. et al. Inflammatory gradient in Barrett's oesophagus: implications for disease complications. Gut 51, 316–322 (2002).
Fitzgerald, R. C. et al. Diversity in the oesophageal phenotypic response to gastro-oesophageal reflux: immunological determinants. Gut 50, 451–459 (2002).
Buttar, N. S. et al. Chemoprevention of esophageal adenocarcinoma by COX-2 inhibitors in an animal model of Barrett's esophagus. Gastroenterology 122, 1101–1112 (2002).
Liu, T. et al. Regulation of Cdx2 expression by promoter methylation, and effects of Cdx2 transfection on morphology and gene expression of human esophageal epithelial cells. Carcinogenesis 28, 488–496 (2007).
Pera, M. et al. Duodenal-content reflux into the esophagus leads to expression of Cdx2 and Muc2 in areas of squamous epithelium in rats. J. Gastrointest. Surg. 11, 869–874 (2007).
Phillips, R. W., Frierson, H. F. Jr & Moskaluk, C. A. Cdx2 as a marker of epithelial intestinal differentiation in the esophagus. Am. J. Surg. Pathol. 27, 1442–1447 (2003).
Krishnadath, K. K. Novel findings in the pathogenesis of esophageal columnar metaplasia or Barrett's esophagus. Curr. Opin. Gastroenterol. 23, 440–445 (2007).
Seery, J. P. Stem cells of the oesophageal epithelium. J. Cell Sci. 115, 1783–1789 (2002).
Dvorak, K. et al. Activation of the interleukin-6/STAT3 antiapoptotic pathway in esophageal cells by bile acids and low pH: relevance to barrett's esophagus. Clin. Cancer Res. 13, 5305–5313 (2007).
Kazumori, H., Ishihara, S. & Kinoshita, Y. Roles of caudal-related homeobox gene Cdx1 in oesophageal epithelial cells in Barrett's epithelium development. Gut 58, 620–628 (2009).
Kazumori, H., Ishihara, S., Rumi, M. A., Kadowaki, Y. & Kinoshita, Y. Bile acids directly augment caudal related homeobox gene Cdx2 expression in oesophageal keratinocytes in Barrett's epithelium. Gut 55, 16–25 (2006).
Chao, D. L. et al. Cell proliferation, cell cycle abnormalities, and cancer outcome in patients with Barrett's esophagus: a long-term prospective study. Clin. Cancer Res. 14, 6988–6995 (2008).
Lin, O. S. et al. Blinded comparison of esophageal capsule endoscopy versus conventional endoscopy for a diagnosis of Barrett's esophagus in patients with chronic gastroesophageal reflux. Gastrointest. Endosc. 65, 577–583 (2007).
Galmiche, J. P. et al. Screening for esophagitis and Barrett's esophagus with wireless esophageal capsule endoscopy: a multicenter prospective trial in patients with reflux symptoms. Am. J. Gastroenterol. 103, 538–545 (2008).
Cotruta, B., Gheorghe, C. & Bancila, I. Magnifying endoscopy with narrow-band imaging or confocal laser endomicroscopy for in vivo rapid diagnostic of Barrett's esophagus. J. Gastrointestin. Liver Dis. 18, 258–259 (2009).
Curvers, W. et al. Chromoendoscopy and narrow-band imaging compared with high-resolution magnification endoscopy in Barrett's esophagus. Gastroenterology 134, 670–679 (2008).
Curvers, W. L. et al. Mucosal morphology in Barrett's esophagus: interobserver agreement and role of narrow band imaging. Endoscopy 40, 799–805 (2008).
Fock, K. M., Teo, E. K., Ang, T. L., Tan, J. Y. & Law, N. M. The utility of narrow band imaging in improving the endoscopic diagnosis of gastroesophageal reflux disease. Clin. Gastroenterol. Hepatol. 7, 54–59 (2009).
Lee, M. M. & Enns, R. Narrow band imaging in gastroesophageal reflux disease and Barrett's esophagus. Can. J. Gastroenterol. 23, 84–87 (2009).
Mannath, J., Subramanian, V., Hawkey, C. J. & Ragunath, K. Narrow band imaging for characterization of high grade dysplasia and specialized intestinal metaplasia in Barrett's esophagus: a meta-analysis. Endoscopy 42, 351–359 (2010).
Sharma, P. et al. The utility of a novel narrow band imaging endoscopy system in patients with Barrett's esophagus. Gastrointest. Endosc. 64, 167–175 (2006).
Singh, R. et al. Narrow-band imaging with magnification in Barrett's esophagus: validation of a simplified grading system of mucosal morphology patterns against histology. Endoscopy 40, 457–463 (2008).
Suzuki, H. & Saito, Y. Autofluorescence and narrow-band imaging endoscopy for detecting early-staged cancer in Barrett's esophagus: a case report. Jpn. J. Clin. Oncol. 38, 871 (2008).
Wolfsen, H. C. et al. Prospective, controlled tandem endoscopy study of narrow band imaging for dysplasia detection in Barrett's Esophagus. Gastroenterology 135, 24–31 (2008).
Sharma, P. et al. Magnification chromoendoscopy for the detection of intestinal metaplasia and dysplasia in Barrett's oesophagus. Gut 52, 24–27 (2003).
Goetz, M., Hoffman, A., Galle, P. R., Neurath, M. F. & Kiesslich, R. Confocal laser endoscopy: new approach to the early diagnosis of tumors of the esophagus and stomach. Future Oncol. 2, 469–476 (2006).
Goetz, M. & Kiesslich, R. Confocal endomicroscopy: in vivo diagnosis of neoplastic lesions of the gastrointestinal tract. Anticancer Res. 28, 353–360 (2008).
Kiesslich, R. et al. Confocal laser endoscopy for diagnosing intraepithelial neoplasias and colorectal cancer in vivo. Gastroenterology 127, 706–713 (2004).
Kiesslich, R. & Canto, M. I. Confocal laser endomicroscopy. Gastrointest. Endosc. Clin. N. Am. 19, 261–272 (2009).
Kiesslich, R., Goetz, M. & Neurath, M. F. Confocal laser endomicroscopy for gastrointestinal diseases. Gastrointest. Endosc. Clin. N. Am. 18, 451–466 (2008).
Kiesslich, R., Goetz, M., Vieth, M., Galle, P. R. & Neurath, M. F. Confocal laser endomicroscopy. Gastrointest. Endosc. Clin. N. Am. 15, 715–731 (2005).
Kiesslich, R., Goetz, M., Vieth, M., Galle, P. R. & Neurath, M. F. Technology insight: confocal laser endoscopy for in vivo diagnosis of colorectal cancer. Nat. Clin. Pract. Oncol. 4, 480–490 (2007).
Kiesslich, R. & Neurath, M. F. Endoscopic confocal imaging. Clin. Gastroenterol. Hepatol. 3, S58–S60 (2005).
Meining, A. et al. In vivo histopathology for detection of gastrointestinal neoplasia with a portable, confocal miniprobe: an examiner blinded analysis. Clin. Gastroenterol. Hepatol. 5, 1261–1267 (2007).
Polglase, A. L. et al. A fluorescence confocal endomicroscope for in vivo microscopy of the upper- and the lower-GI tract. Gastrointest. Endosc. 62, 686–695 (2005).
Borovicka, J. et al. Autofluorescence endoscopy in surveillance of Barrett's esophagus: a multicenter randomized trial on diagnostic efficacy. Endoscopy 38, 867–872 (2006).
Curvers, W. L. et al. Endoscopic tri-modal imaging for detection of early neoplasia in Barrett's oesophagus: a multi-centre feasibility study using high-resolution endoscopy, autofluorescence imaging and narrow band imaging incorporated in one endoscopy system. Gut 57, 167–172 (2008).
Curvers, W. L. et al. Identification of predictive factors for early neoplasia in Barrett's esophagus after autofluorescence imaging: a stepwise multicenter structured assessment. Gastrointest. Endosc. 70, 9–17 (2009).
Falk, G. W. Autofluorescence endoscopy. Gastrointest. Endosc. Clin. N. Am. 19, 209–220 (2009).
Kara, M. A., Peters, F. P., Fockens, P., ten Kate, F. J. & Bergman, J. J. Endoscopic video-autofluorescence imaging followed by narrow band imaging for detecting early neoplasia in Barrett's esophagus. Gastrointest. Endosc. 64, 176–185 (2006).
Kara, M. A. et al. Endoscopic video autofluorescence imaging may improve the detection of early neoplasia in patients with Barrett's esophagus. Gastrointest. Endosc. 61, 679–685 (2005).
Fennerty, M. B. Does chemoprevention of Barrett's esophagus using acid suppression and/or COX-2 inhibition prevent neoplastic progression? Rev. Gastroenterol. Disord. 2 (Suppl. 2), S30–S37 (2002).
Fennerty, M. B. Barrett's-related esophageal cancer: has the final hurdle been cleared, now paving the way for human chemoprevention trials? Gastroenterology 122, 1172–1175 (2002).
Umansky, M. et al. Proton pump inhibitors reduce cell cycle abnormalities in Barrett's esophagus. Oncogene 20, 7987–7991 (2001).
Bateman, D. N. et al. Mortality study of 18,000 patients treated with omeprazole. Gut 52, 942–946 (2003).
Farrow, D. C. et al. Use of aspirin and other nonsteroidal anti-inflammatory drugs and risk of esophageal and gastric cancer. Cancer Epidemiol. Biomarkers Prev. 7, 97–102 (1998).
Funkhouser, E. M. & Sharp, G. B. Aspirin and reduced risk of esophageal carcinoma. Cancer 76, 1116–1119 (1995).
Thun, M. J., Namboodiri, M. M., Calle, E. E., Flanders, W. D. & Heath, C. W. Jr. Aspirin use and risk of fatal cancer. Cancer Res. 53, 1322–1327 (1993).
Morris, C. D., Armstrong, G. R., Bigley, G., Green, H. & Attwood, S. E. Cyclooxygenase-2 expression in the Barrett's metaplasia–dysplasia–adenocarcinoma sequence. Am. J. Gastroenterol. 96, 990–996 (2001).
Heath, E. I. et al. Secondary chemoprevention of Barrett's esophagus with celecoxib: results of a randomized trial. J. Natl Cancer Inst. 99, 545–557 (2007).
El-Serag, H. B. et al. Proton pump inhibitors are associated with reduced incidence of dysplasia in Barrett's esophagus. Am. J. Gastroenterol. 99, 1877–1883 (2004).
Ouatu-Lascar, R., Fitzgerald, R. C. & Triadafilopoulos, G. Differentiation and proliferation in Barrett's esophagus and the effects of acid suppression. Gastroenterology 117, 327–335 (1999).
Feagins, L. A. et al. Acid has antiproliferative effects in nonneoplastic Barrett's epithelial cells. Am. J. Gastroenterol. 102, 10–20 (2007).
Hillman, L. C., Chiragakis, L., Shadbolt, B., Kaye, G. L. & Clarke, A. C. Proton-pump inhibitor therapy and the development of dysplasia in patients with Barrett's oesophagus. Med. J. Aust. 180, 387–391 (2004).
Overholt, B. F. et al. Five-year efficacy and safety of photodynamic therapy with Photofrin in Barrett's high-grade dysplasia. Gastrointest. Endosc. 66, 460–468 (2007).
Prasad, G. A. et al. Predictors of stricture formation after photodynamic therapy for high-grade dysplasia in Barrett's esophagus. Gastrointest. Endosc. 65, 60–66 (2007).
Wolfsen, H. C., Hemminger, L. L., Wallace, M. B. & Devault, K. R. Clinical experience of patients undergoing photodynamic therapy for Barrett's dysplasia or cancer. Aliment. Pharmacol. Ther. 20, 1125–1131 (2004).
Prasad, G. A. et al. Significance of neoplastic involvement of margins obtained by endoscopic mucosal resection in Barrett's esophagus. Am. J. Gastroenterol. 102, 2380–2386 (2007).
Shaheen, N. J. et al. Radiofrequency ablation in Barrett's esophagus with dysplasia. N. Engl. J. Med. 360, 2277–2288 (2009).
Sharma, V. K. et al. Balloon-based, circumferential, endoscopic radiofrequency ablation of Barrett's esophagus: 1-year follow-up of 100 patients. Gastrointest. Endosc. 65, 185–195 (2007).
Fleischer, D. E. et al. Endoscopic ablation of Barrett's esophagus: a multicenter study with 2.5-year follow-up. Gastrointest. Endosc. 68, 867–876 (2008).
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Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.
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Badreddine, R., Wang, K. Barrett esophagus: an update. Nat Rev Gastroenterol Hepatol 7, 369–378 (2010). https://doi.org/10.1038/nrgastro.2010.78
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DOI: https://doi.org/10.1038/nrgastro.2010.78
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