Endoscopic Diagnosis and Treatment of Superficial Barrett Adenocarcinoma
Is Barrett's esophagus an over-hyped disease in the West, and an underdiagnosed disease in the East?
Article first published online: 25 APR 2013
© 2013 The Authors. Digestive Endoscopy © 2013 Japan Gastroenterological Endoscopy Society
Special Issue: Proceedings of the Endoscopy Forum Japan 2012. Guest Editors: Atsushi Kawaguchi, Shinji Tanaka and Kenjiro Yasuda. This supplement was published with the support of Olympus Medical Systems Corporation.
Volume 25, Issue Supplement S2, pages 157–161, May 2013
How to Cite
Ho, K.-Y. and Asia-Pacific Barrett's Consortium (2013), Is Barrett's esophagus an over-hyped disease in the West, and an underdiagnosed disease in the East?. Digestive Endoscopy, 25: 157–161. doi: 10.1111/den.12105
- Issue published online: 25 APR 2013
- Article first published online: 25 APR 2013
- Manuscript Accepted: 28 FEB 2013
- Manuscript Received: 7 JAN 2013
- Barrett's esophagus;
- imaging technology;
Despite the widespread practice of endoscopic surveillance for Barrett's esophagus in the West, this strategy has not been shown to reduce mortality from esophageal adenocarcinoma. Coupled with the very low absolute annual risk of Barrett's adenocarcinoma of 0.1%, this has called into question as to whether Barrett's esophagus is an over-hyped condition in the West. On the contrary, it is widely assumed that the prevalence of Barrett's esophagus is low in Asia. Could there be under-recognition of Barrett's esophagus, resulting in the underdiagnosis of the disease in the region? Our own study noted a much higher prevalence of histologically confirmed Barrett's esophagus following increased interest in endoscopic investigation of this disease, suggesting the low prevalence of Barrett's esophagus reported in most parts of Asia could have been attributed, at least in part, to underdiagnosis and/or lack of awareness of the condition. Training in the use of standardized diagnostic criteriacould enhance diagnosis of the disease. In a recent study conducted by the Asia-Pacific Barrett's Consortium, formal training in the endoscopic recognition of columnar-lined Barrett's segment enhanced endoscopists' detection of the disease and led to significantly higher diagnostic yield (1.5% vs 0.42% in untrained endoscopists). The use of advanced endoscopic imaging technology such as narrow-band imaging improved the negative predictive value in the diagnosis of Barrett's esophagus's associated neoplasia. Raman spectroscopy, a novel biomolecular probe-based technology that does not rely upon operator's interpretation of images, could potentially enhance the detection of Barrett's esophagus and associated neoplasia.