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Barrett’s Esophagus and Cancer Risk: How Research Advances Can Impact Clinical Practice

机译：巴雷特的食道和癌症风险：研究进展如何影响临床实践

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Barrett’s esophagus (BE) is the only known precursor to esophageal adenocarcinoma (EAC), whose incidence has increased sharply in the last 4 decades. The annual conversion rate of BE to cancer is significant, but small. The identification of patients at a higher risk of cancer therefore poses a clinical conundrum. Currently, endoscopic surveillance is recommended in BE patients, with the aim of diagnosing either dysplasia or cancer at early stages, both of which are curable with minimally invasive endoscopic techniques. There is a large variation in clinical practice for endoscopic surveillance, and dysplasia as a marker of increased risk is affected by sampling error and high interobserver variability. Screening programs have not yet been formally accepted, mainly due to the economic burden that would be generated by upper gastrointestinal endoscopy. Screening programs have not yet been formally accepted, mainly due to the economic burden that would be generated by widespread indication to upper gastrointestinal endoscopy. In fact, it is currently difficult to formulate an accurate algorithm to confidently target the population at risk, based on the known clinical risk factors for BE and EAC. This review will focus on the clinical and molecular factors that are involved in the development of BE and its conversion to cancer and on how increased knowledge in these areas can improve the clinical management of the disease.
机译：巴雷特食管（BE）是食道腺癌（EAC）的唯一已知前体，在过去的40年中，其发病率急剧上升。每年BE转化为癌症的转化率很高，但很小。因此，对具有较高癌症风险的患者的鉴定带来了临床难题。当前，建议在BE患者中进行内窥镜监测，以早期诊断不典型增生或癌症，这两种疾病均可通过微创内窥镜技术治愈。内窥镜监测的临床实践存在很大差异，并且不典型增生是增加风险的标志，并且会受到采样误差和观察者间差异较大的影响。筛查程序尚未被正式接受，主要是由于上消化道内窥镜检查会产生经济负担。筛查程序尚未被正式接受，这主要是由于上胃肠道内窥镜检查的广泛征兆会产生经济负担。实际上，基于BE和EAC的已知临床风险因素，目前很难制定一种准确的算法来确定目标人群的风险。这篇综述将着重于BE的发展及其转化为癌症所涉及的临床和分子因素，以及在这些领域中增加的知识如何改善该疾病的临床管理。

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