Update on the management of Barrett’s neoplasia
Sharmila Subramaniam et al.
La revisione è importante perché aggiorna la gestione delle neoplasie di Barrett in un articolo di Frontline Gastroenterology del 2026, quindi ha un valore pratico diretto per la diagnosi e il trattamento. 1Il ruolo dell’imaging di alta qualità è centrale perché migliora l’identificazione e la caratterizzazione delle lesioni, rendendo più affidabili le decisioni cliniche e le procedure endoscopiche. 2
La revisione è importante perché aggiorna la gestione delle neoplasie di Barrett in un articolo di Frontline Gastroenterology del 2026, quindi ha un valore pratico diretto per la diagnosi e il trattamento.Il ruolo dell’imaging di alta qualità è centrale perché migliora l’identificazione e la caratterizzazione delle lesioni, rendendo più affidabili le decisioni cliniche e le procedure endoscopiche.In sintesi, il messaggio chiave è che una valutazione visiva accurata e tecnicamente ottimale cambia davvero la qualità della diagnosi e del percorso terapeutico.
Abstract
Barrett’s oesophagus is a premalignant condition with a rising incidence in the West and an important factor in the development of oesophageal adenocarcinoma. Barrett’s oesophagus surveillance is recommended to identify neoplasia at an early stage. High-quality endoscopic assessment with enhanced imaging or chromoendoscopy with biopsies remains the standard of assessment although newer modalities including the use of artificial intelligence may enhance identification of neoplasia. Endoscopic management is the recommended strategy for treatment of early Barrett’s neoplasia with a combination of resection and ablation. Radiofrequency ablation is the main ablation modality although cryoablation and argon plasma coagulation (APC) show promise as primary and salvage ablation treatments. The choice of endoscopic resection modality (endoscopic mucosal resection or endoscopic submucosal dissection (ESD)) is largely influenced by lesion size, morphology and endoscopic assessment of the suspected depth of invasion. ESD has an expanding role as en bloc resection with accurate histological staging can be achieved in large lesions, submucosally invasive cancers and in recurrent disease. Radical resection strategies may be associated with higher stricture rates and new treatments to manage this are emerging. Recurrence after clearance of dysplasia or intestinal metaplasia is well recognised and risk-based endoscopic surveillance is recommended with close inspection and targeted biopsies. Most early recurrences are still amenable to curative endoscopic resection, particularly with the use of ESD.
Figure 1
Surveillance in Barrett’s oesophagus. EET, endoscopic eradication therapy; HGD, high-grade dysplasia; LGD, low-grade dysplasia; PPI, proton pump inhibitor
Figure 2
Management of Barrett’s neoplasia. *High-risk features: · Poor differentiation and/or signet ring cell. · Lymphovascular invasion. **Consider surgery/chemotherapy/strict endoscopic follow-up with CT/endoscopy/EUS if unsuitable for this. EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection; EUS, endoscopic ultrasound; HGD, high-grade dysplasia; LGD, low-grade dysplasia; MDT, multidiscipinary team meeting; PPI, proton pump inhibitor; SM, submucosal invasion.
Figure 3
High-quality assessment of Barrett’s oesophagus. BING, Barrett’s International NBI Group; BLI, blue-light imaging, BLINC, blue light imaging for Barrett’s Neoplasia Classification; HDWL, high definition white light; NBI, narrow-band imaging.
LEGGI TUTTO https://fg.bmj.com/content/17/e1/e23#:~:text=https%3A//doi.org/10.1136/flgastro%2D2026%2D103740
