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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. May 16, 2015; 7(5): 438-445
Published online May 16, 2015. doi: 10.4253/wjge.v7.i5.438
Risk factors affecting the Barrett's metaplasia-dysplasia-neoplasia sequence
Craig S Brown, Michael B Ujiki
Craig S Brown, Pritzker School of Medicine, Biological Sciences Division, University of Chicago, Chicago, IL 60637, United States
Craig S Brown, Michael B Ujiki, Department of Surgery, North Shore University Health Systems, Evanston, IL 60201, United States
Author contributions: Brown CS and Ujiki MB solely contributed to this paper.
Conflict-of-interest: Dr. Michael B Ujiki has received consultant fees from Olympus and Covidien, as well as speaker honoraria from Covidien, Apollo Endo, and GORE. Craig S Brown has no conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Michael B Ujiki, MD, Department of Surgery, North Shore University Health Systems, 2650 Ridge Avenue, Evanston, IL 60201, United States. mujiki@northshore.org
Telephone: +1-847-5701700
Received: August 29, 2014
Peer-review started: August 30, 2014
First decision: October 14, 2014
Revised: November 25, 2014
Accepted: January 18, 2015
Article in press: January 20, 2015
Published online: May 16, 2015
Abstract

Esophageal adenocarcinoma has the fastest growing incidence rate of any cancer in the United States, and currently carries a very poor prognosis with 5 years relative survival rates of less than 15%. Current curative treatment options are limited to esophagectomy, a procedure that suffers from high complication rates and high mortality rates. Metaplasia of the esophageal epithelium, a condition known as Barrett’s esophagus (BE), is widely accepted as the precursor lesion for adenocarcinoma of the esophagus. Recently, radio-frequency ablation has been shown to be an effective method to treat BE, although there is disagreement as to whether radio-frequency ablation should be used to treat all patients with BE or whether treatment should be reserved for those at high risk for progressing to esophageal adenocarcinoma while continuing to endoscopically survey those with low risk. Recent research has been targeted towards identifying those at greater risk for progression to esophageal adenocarcinoma so that radio-frequency ablation therapy can be used in a more targeted manner, decreasing the total health care cost as well as improving patient outcomes. This review discusses the current state of the literature regarding risk factors for progression from BE through dysplasia to esophageal adenocarcinoma, as well as the current need for an integrated scoring tool or risk stratification system capable of differentiating those patients at highest risk of progression in order to target these endoluminal therapies.

Keywords: Barrett’s esophagus, Esophageal adenocarcinoma, Endoscopy, Risk factors, Radiofrequency ablation, Antireflux surgery

Core tip: The transformation of Barrett’s esophagus to dysplasia and finally to esophageal adenocarcinoma is a multifactorial process encompassing effects from multiple known and unknown risk factors. Previously, radiofrequency ablation was reserved for use in high risk patients with high-grade dysplasia, but recent evidence supports the expansion of this technique to be potentially used to treat additional patients at moderate risk of progression, such as those with long segments, long duration of symptoms, and those patients who are unable or unwilling to take proton-pump inhibitors’s.