Barrett's oesophagus and stage 1 oesophageal adenocarcinoma: monitoring and management

Context

Barrett's oesophagus is a condition in which squamous cells at the lower end of the lining of the oesophagus are replaced with columnar cells. It can be a precursor to oesophageal adenocarcinoma. Barrett's oesophagus is more common in older age groups, men, people who are white and people who are overweight. The risk of progression to cancer is low. Fewer than 1% of people with Barrett's oesophagus develop oesophageal adenocarcinoma each year.

However, oesophageal adenocarcinoma has a poor prognosis because of late presentation, and its incidence is increasing possibly related to more people being overweight or obese. Effective treatments for Barrett's oesophagus could reduce the number of people presenting late with adenocarcinoma and improve overall outcomes.

NICE published a guideline on ablative therapy for Barrett's oesophagus (CG106) in 2010, which included people with high-grade dysplasia only. The British Society of Gastroenterology published guidance in 2013 on managing Barrett's oesophagus and related early neoplasia. This emphasised the importance of minimum data set reporting, including length of Barrett's segments and also the requirement that dysplasia is confirmed by 2 gastrointestinal pathologists. An update to the 2010 NICE guideline was needed because of new evidence on chemoprevention, managing Barrett's oesophagus with low-grade dysplasia and evolving practice in stage 1 adenocarcinoma.