Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2016; 22(47): 10316-10324
Published online Dec 21, 2016. doi: 10.3748/wjg.v22.i47.10316
Evolving management of metaplasia and dysplasia in Barrett's epithelium
Richard P T Evans, Moustafa Mabrouk Mourad, Simon G Fisher, Simon R Bramhall
Moustafa Mabrouk Mourad, Simon G Fisher, Simon R Bramhall, Richard PT Evans, Department of Surgery, the Wye Valley NHS Trust, HR1 2ER Hereford, United Kingdom
Author contributions: Evans RPT designed the study; Evans RPT, Mourad MM and Fisher SG collected, analysed, interpreted the data, and drafted the article; Evans RPT and Bramhall SR designed the conception, critically revised the manuscript for important intellectual content, and made the final approval of the version to be published.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
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:
Correspondence to: Dr. Simon R Bramhall, Department of Surgery, the Wye Valley NHS Trust, Vaughan Building/Ruckhall La, Hereford HR1 2ER, United Kingdom.
Telephone: +44-7976-278549 Fax: + 44-1432-364102
Received: September 20, 2016
Peer-review started: September 20, 2016
First decision: October 10, 2016
Revised: October 30, 2016
Accepted: December 2, 2016
Article in press: December 2, 2016
Published online: December 21, 2016

Oesophageal cancer affects more than 450000 people worldwide and despite continued medical advancements the incidence of oesophageal cancer is increasing. Oesophageal cancer has a 5 year survival of 15%-25% and now globally attempts are made to more aggressively diagnose and treat Barrett’s oesophagus the known precursor to invasive disease. Currently diagnosis the of Barrett’s oesophagus is predominantly made after endoscopic visualisation and histopathological confirmation. Minimally invasive techniques are being developed to improve the viability of screening programs. The management of Barrett’s oesophagus can vary greatly dependent on the presence and severity of dysplasia. There is no consensus between the major international medical societies to determine and agreed surveillance and intervention pathway. In this review we analysed the current literature to demonstrate the evolving management of metaplasia and dysplasia in Barrett’s epithelium.

Keywords: Barrett’s, Oesophagus, Dysplasia, Metaplasia, Oesophageal cancer

Core tip: Barrett's esophagus is a premalignant condition. Its malignant sequela, esophagogastric junctional adenocarcinoma, has a mortality rate of over 85%. The risk of developing esophageal adenocarcinoma in people who have Barrett's esophagus has been estimated to be 6-8 per 1000 person-years. Early identification of Barrett’s and adjusted management is very important to decrease oesophageal cancer related deaths worldwide.