Endoscopic Management of Dysplastic Barrett’s Oesophagus and Early Oesophageal Adenocarcinoma

SIMPLE SUMMARY: Among individuals with gastro-esophageal reflux disease, the prevalence of histologically confirmed BO is around 7%, with variations according to different geographical regions. Since Barrett’s oesophagus may progress to cancer through various stages of dysplasia, a correct diagnosis is pivotal in the management of patients with Barrett, made through accurate endoscopic examination and tissue sampling. The management of BO depends most strongly on the presence and severity of dysplasia, thus regular endoscopic surveillance and biopsies are required to monitor for neoplastic progression. In the presence of Barrett’s-associated neoplasia, endoscopic treatments are utilised, including resection techniques and ablation therapies, and long-term data support their safety and efficacy. However, they are not without risk, and for the optimal management of BO-associated neoplasia, it is recommended that patients are referred to expert centres. ABSTRACT: Barrett’s oesophagus is a pathological condition whereby the normal oesophageal squamous mucosa is replaced by specialised, intestinal-type metaplasia, which is strongly linked to chronic gastro-oesophageal reflux. A correct endoscopic and histological diagnosis is pivotal in the management of Barrett’s oesophagus to identify patients who are at high risk of progression to neoplasia. The presence and grade of dysplasia and the characteristics of visible lesions within the mucosa of Barrett’s oesophagus are both important to guide the most appropriate endoscopic therapy. In this review, we provide an overview on the management of Barrett’s oesophagus, with a particular focus on recent advances in the diagnosis and recommendations for endoscopic therapy to reduce the risk of developing oesophageal adenocarcinoma.