Barrett’s oesophagus is typically diagnosed on endoscopy: the characteristic appearance of a Barrett’s oesophagus is shown in Figure 2. In addition to endoscopy, a biopsy is performmed. This involves taking a sample of tissue from the oesophagus to examine it under microscope. As mentioned before, the usual squamous cellular structure is replaced with a columnar cellular structure.
In medicine, screening is a technique used to identify disease in patients who do not currently have any characteristic signs / symptoms of the disease. For Barrett’s oesophagus, there is no evidence that screening lowers the mortality rate; as such, screening for the disease remains controversial (1) and is not offered to the general population. However, screening is recommended in the following high-risk patient groups (2):
After a diagnosis of Barrett’s Oesophagus, surveillance programmes are used to monitor the progression of disease and identify complications as early as possible. In Barrett’s oesophagus, surveillance programmes involve regular (upper gastrointestinal) endoscopic procedures to identify dysplasia (the development of abnormal cells that represent a pre-cancerous stage) or cancer. Dysplasia can be graded according to its severity, with high-grade dysplasia being a more severe state than low-grade dysplasia. Dysplasia is detected using high-resolution, white-light endoscopy with biopsies (3). If malignant disease is detected early enough, interventions can be introduced to reduce disease mortality.
Although dysplasia is a pre-cursor to adenocarcinoma in Barrett’s patients, some patients with non-dysplatic Barrett’s oesophagus may also develop oesophageal adenocarcinoma. The yearly percentage progression to adenocarcinoma is 0.33% in patients with non-dysplatic disease compared to 10% in patients with dysplastic adenocarcinoma (4,5).
The guidelines for surveillance of Barrett’s oesophagus (a) is not recommended if life-expectancy is <5 years and (b) varies depending on the gastroenterology society. In addition to disease surveillance, doctors need to:
Patients with a <3cm Barrett’s oesophagus segment and without intestinal metaplasia (the cells change from flat to columnar in appearance)should be discharged from a surveillance programme. This needs to be confirmed on two successive endoscopies. However, if intestinal metaplasia is present, the patient should not be discharged (6).