Barrett’s esophagus: A review of diagnostic criteria, clinical surveillance practices and new developments

Barrett’s esophagus is defined by metaplastic glandular changes to the distal esophagus and is
linked to an increased risk of esophageal adenocarcinoma. Controversy exists whether the definition should
be limited to intestinal type glands with goblet cells or should be expanded to include non-goblet cell
columnar epithelium. Barrett’s esophagus may be asymptomatic in a large proportion of the population but
screening should be considered for those with certain clinical findings. The diagnosis of Barrett’s should
be based on the combination of careful endoscopic evaluation and histologic review of the biopsy material.
Continued surveillance biopsies may be necessary in cases of indeterminate or low grade dysplasia. Clinical
follow-up of patients with high grade dysplasia should be tailored to the individual patient. Development of
newer endoscopy techniques including chemoendoscopy, chromoendoscopy and use of biomarkers on frozen
tissue have shown some promise of identifying patients at risk for malignancy.