When to Ablate and When to Cut in Barrett Esophagus - East vs. West 22 Aug 2021 10:44 10:56

When to Ablate and When to Cut in Barrett Esophagus - East vs. West 22 Aug 2021 10:44 10:56

(12 mins)
Takuji Gotoda Speaker
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Barrett’s Esophagus (BE), a premalignant condition of the lower esophagus, is increasingly prevalent in Asia. However, endoscopic and histopathological criteria vary widely between studies across Asia, making it challenging to assess comparability between geographical regions. Furthermore, guidelines from various societies worldwide provide differing viewpoints and definitions, leading to diagnostic challenges that affect the prognostication of the condition. Many decades after the discovery of BE, we now know its risk factors in Asia such as old age, male gender, visceral obesity, smoking, alcohol consumption, presence of a hiatus hernia, chronic reflux symptoms and negative Helicobacter Pylori status. Compared to the United States, where the prevalence of BE is approximately 5.6%, in Asia, this ranges widely from 0.06% to 43% and comprise mainly of short-segment BE. Outside Japan, however, its prevalence in the rest of Asia only ranges between 0.06% to 6.2%. A recently updated meta-analysis of 51 Asian studies published in 2015 revealed a pooled prevalence of endoscopic BE of 7.8%. Histologically, the prevalence of BE was 1.3%, defined here as the presence of specialized Intestinal Metaplasia (IM), of which 82.1% were short-segment BE (SSBE). Ultimately, the clinical implication of BE lies in the risk of Esophageal Adenocarcinoma (EAC), which increases with the length of BE. In Asia, although the prevalence of BE is generally considered low, the incidence of GERD has been increasing, with the growing influence of Western cultures. Consequently, the increasing prevalence of BE and adenocarcinoma of the GEJ in Asia was later confirmed in recent studies. However, in these prevalence studies, endoscopic and histopathological criteria varied between studies, making it challenging to assess comparability between geographical regions. Thus, the Asian Barrett’s Consortium needs to standardize the diagnosis of BE in Asia.
 
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