Endoscopic management of Barrett's esophagus: Western perspective of current status and future prospects

Barrett's esophagus (BE) is a precursor to esophageal adenocarcinoma and current practice is to establish endoscopic surveillance once diagnosed, in order to identify early dysplasia and neoplasia that has the potential to undergo endoscopic eradication therapy (EET). Before embarking upon EET the clinical team has a duty to consider all viable options and come to a plan based on recent evidence. The therapeutic approach varies greatly but largely adheres to the mantra of 'Detect-Resect-Ablate', in which high-quality endoscopy identifies BE associated pathology, associated lesions (if present) undergo safe endoscopic resection and remaining intestinal metaplasia in the esophagus is ablated to prevent recurrence of dysplasia. In this review, current practice, pitfalls, complications, and the future perspectives on practice in this field are discussed. The Western perspective is focused on here, with an outline of the differences in clinical practice with Asian nations and attempts to bridge these differences.

Automated summary

Barrett's esophagus is a precursor to esophageal adenocarcinoma, and endoscopic surveillance followed by endoscopic eradication therapy is the current practice. The mantra of 'Detect-Resect-Ablate' guides the therapeutic approach, emphasizing the importance of high-quality endoscopy in identifying associated pathology and preventing dysplasia recurrence. The review discusses current practices, pitfalls, complications, and future perspectives in this field, with a focus on bridging clinical practice differences between Western and Asian nations.