Published online May 16, 2015. doi: 10.4253/wjge.v7.i5.438
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
Processing time: 262 Days and 9.3 Hours
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.
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.