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Oncological Perspectives in Barrett’s Esophagus

October-December 2015, Volume 02, Number 4
Osvaldo A. Quiroz-Sandoval, Alejandro E. Padilla-Rosciano, Horacio N. López-Basave, Alberto M. León-Takahashi, Leonardo S. Lino-Silva and Ángel Herrera-Gómez
Department of Gastrointestinal Tumors, Instituto Nacional de Oncología (INCan), Mexico City, Mexico

Barrett’s esophagus refers to an acquired condition in which the normal squamous esophageal epithelium is replaced by a specialized type of columnar epithelium. Patients with Barrett’s esophagus have a 30-60-fold greater risk of developing adenocarcinoma of the esophagus than the rest of the population; however only a small percentage of the population develops it. Even though its cause is unknown, it is related to chronic gastroesophageal reflux disease. Nevertheless, the relationship between gastroesophageal reflux disease and the risk of developing cancer of the esophagus has shown that an increase in the frequency, seriousness, and chronicity of the symptoms of reflux could be related to a increase of up to 2-16-fold in the risk of developing adenocarcinoma, irrespective of the presence of Barrett’s esophagus.

Tumors of the esophagogastric junction classified as Siewert I have a relationship of close to 80%, whereas the presence of Barrett’s esophagus is only associated in 5.6 and 0.8% for Siewert II and III tumors of the esophagogastric junction, respectively.

Without any treatment, the invasive cancer develops in up to 50% of patients with Barrett’s esophagus and high-grade dysplasia over the course of three years. Endoscopic techniques for the resection and ablation of the metaplastic mucous are reserved for patients with high-grade dysplasia because of the elevated risk of progression to adenocarcinoma. In young patients with high-grade, multifocal dysplasia, whose condition has not been eradicated after one year of endoscopic treatment and with low surgical risk, vagus-preserving esophagectomy is considered the first treatment option.

Key words:
Barrett’s esophagus. Metaplasia. Dysplasia. Adenocarcinoma. Ablation. Vagus preserving esophagectomy.
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