Barrett oesophagus and adenocarcinoma: an overview of epidemiologic, conceptual and clinical issues

A steady increase in the incidence of adenocarcinoma of the oesophagus and oesophagogastric junction has been observed in Western countries. Patients with distinctive-type Barrett oesophagus are predisposed to developing aden ocarcinoma of the oesophagus. Distinct! e-ty pe Barrett oesophagus is defin ed by the presence of intestinal-like goblet cells anywhere in the oesophag us. Adenocarcinomas of the oesophagogastric Junction may be associated with short segments of intestinal-type columnar epithelium in the distal oesoph agus. Prognosis after surgical resection for cancer of the oesophagus or oe sophagogastric junction is strongly affected by the extent of the disease a t the time of diagnosis. The identification of Barrett oesophagus as a prem alignant condition. the recognition of a stepwise neoplastic progression. a long with the poor Survival rates of advanced oesophageal adenocarcinoma ha ve initiated the practice of endoscopic biopsy surveillance for patients wi th Barrett oesophagus. There is supporting evidence that endoscopic biopsy surveillance of Barrett oesophagus permits detection of malignancy at an ea rly stage with favourable results after oesophageal resection. Endoscopic t reatment modalities should at this time not be generally adopted in the man agement of patients with early invasive adenocarcinoma of the oesophagus or oesophagogastric junction.