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Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy
Jacques J.G.H.M. Bergman MD, PhD
Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
Shivaram K. Bhat PhD, MRCP, MBBCh
Specialty Registrar in Gastroenterology, Altnagelvin Hospital, Western Health and Social Care Trust, Londonderry, UK
David F. Boerwinkel MD
Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
Marcia Irene Canto MD, MHS
Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, MA, USA
Daniel K. Chan MD
Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
Helen G. Coleman PhD
Lecturer in Cancer Epidemiology, Centre for Public Health, Queen's University Belfast, Belfast, UK
Wouter L. Curvers MD, PhD
Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
Heath D. Skinner MD, PhD
Assistant Professor, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Mary Denholm MBChB (Oxon) BA (Hons)(Oxon)
Centre for Digestive Diseases, Queen Mary University of London, London, UK
Jacques Deviere MD, PhD
Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Brussels, Belgium
Kerry Dunbar MD, PhD
Assistant Professor of Medicine, University of Texas Southwestern Medical Center, Dallas VA Medical Center, Dallas, TX, USA
Matthias Ebert MD
Department of Medicine II, Gastroenterology, University of Mannheim, Germany
Hashem B. El-Serag MD, MPH
Professor and Chief, Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine; Clinical Epidemiology and Comparative Effectiveness Program, Houston VA HSR&D Center of Excellence, Michael E DeBakey Veterans Affairs Medical Center, Houston, TX, USA
Eun Ji Shin MD
Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, MA, USA
Gary W. Falk MD, MS
Professor of Medicine, Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
Rebecca Fitzgerald FMedSci
MRC Cancer Unit, Hutchison-MRC Research Centre, University of Cambridge, Cambridge, UK
John R. Goldblum MD
Professor, Cleveland Clinic Lerner College of Medicine, Chairman, Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
Takuji Gotoda MD
Division of Gastroenterology, Jichi Medical University, Shimotsuke, Tochigi, Japan
Lars Grenacher MD
Department of Diagnostic and Interventional Radiology, University of Heidelberg, Germany
Neil Gupta MD, MPH
Assistant Professor of Medicine, Division of Gastroenterology and Nutrition, Loyola University Medical Center, Maywood, IL, USA
Toshitaka Hoppo MD, PhD
Institute for the Treatment of Esophageal & Thoracic Disease, The Western Pennsylvania Hospital, Pittsburgh, PA, USA
Janusz Jankowski
Centre for Digestive Diseases, Queen Mary University of London, London, UK
Blair A. Jobe MD, FACS
Chief, Department of Surgery; Director, Institute for the Treatment of Esophageal & Thoracic Disease, The Western Pennsylvania Hospital, Pittsburgh, PA, USA
Manol Jovani MD
Digestive Endoscopy Unit, Division of Gastroenterology
Humanitas Research Hospital, Rozzano, Milan, Italy
Peter Kahrilas MD
Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
Arne Kandulski
Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany
Ralf Kiesslich
Department of Medicine, St. Marienkrankenhaus, Katharina-Kasper gGmbH, Frankfurt am Main, Germany
Bernd-Joachim Krause MD
Department of Nuclear Medicine, University of Rostock, Germany
Kumar Krishnan
Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
Geoffrey Y. Ku MD
Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
Cadman L. Leggett MD
Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
Mark A. Lewis MD
Assistant Professor, General Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Florian Lordick MD
Director of the University Cancer Center Leipzig (UCCL), University Clinic Leipzig, Leipzig, Germany
Kristle Lee Lynch MD
Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, MA, USA
Peter Malfertheiner MD
Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany
Bruce D. Minsky MD
Professor and Deputy Division Head, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Liam J. Murray MFPHM, MD, MRCGP, MBBCh
Professor in Cancer Epidemiology, Centre for Public Health, Queen's University Belfast, Belfast, UK
Mariam Naveed MD
Fellow, Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
Mariam Naveed MD
Fellow, Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
Helmut Neumann
Department of Medicine I, University of Erlangen-Nuremberg, Germany
Ayesha Noorani
MRC Cancer Unit, Hutchison-MRC Research Centre, University of Cambridge, Cambridge, UK
Katja Ott MD
Department of Surgery, University of Heidelberg, Germany
Tsuneo Oyama MD
Division of Gastroenterology, Jichi Medical University, Shimotsuke, Tochigi, Japan
John E. Pandolfino
Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
Deepa T. Patil MD
Assistant Professor, Cleveland Clinic Lerner College of Medicine, Staff Pathologist, Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
Oliver Pech MD, PhD
Department of Gastroenterology and interventional Endoscopy, St. John of God Hospital, Teaching Hospital of the University of Regensburg, Germany
Krish Ragunath MD, FRCP, FASGE
Professor & Head of GI Endoscopy, Nottingham Digestive Diseases Centre, NIHR Biomedical Research Unit, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
Alessandro Repici MD
Digestive Endoscopy Unit, Division of Gastroenterology
Humanitas Research Hospital, Rozzano, Milan, Italy
Nabil Rizk
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Mohammad H. Shakhatreh MD
Gastroenterology Clinical Research Fellow, Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine and Houston VA HSR&D Center of Excellence, Michael E DeBakey Veterans Affairs Medical Center, Houston, TX, USA
Aaron J. Small MD
Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
A. Samad Soudagar MD
Fellow, Division of Gastroenterology and Nutrition, Loyola University Medical Center, Maywood, IL, USA
Stuart Jon Spechler MD
Professor of Medicine, Berta M. and Cecil O. Patterson Chair in Gastroenterology, UT Southwestern Medical Center at Dallas; Chief, Division of Gastroenterology, VA North Texas Healthcare System, Dallas VA Medical Center, Dallas, TX, USA
Marino Venerito
Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany
Kenneth Wang MD
Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
Sachin Wani MD
Assistant Professor of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Veterans Affairs Medical Center, Denver, Aurora, CO, USA
Christian Wittekind MD
Institute of Pathology, University Clinic Leipzig, Germany
Hironori Yamamoto MD, PhD
Professor of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Tochigi, Japan
Harry H. Yoon MD, MHS
Consultant, Medical Oncology, Mayo Clinic, Rochester, MN, USA
Preface
Many advances have occurred in the past few decades in the diagnosis and management of Barrett's esophagus and early esophageal adenocarcinoma. We have attempted to capture the salient features of these lesions in several chapters written by international experts in the field.
Highlights of this book include the recognition of the lower neoplastic progression of Barrett's esophagus (0.2–0.4 % per year), in spite of the rising incidence in younger age groups. Also, the risk factors for esophageal adenocarcinoma are detailed by epidemiology: age, gender and ethnicity. There is a complex interplay of inherited predispositions, environmental exposures and tissue responses that lead to neoplastic progression. Unfortunately, the advances in molecular biology have failed to yield a simple documented approach to the risk stratification of patients. Multiple mutations have been identified and analyzed, with sophisticated statistical techniques, without a clear clinically useful result. Histologic dysplasia remains the “standard” biomarker for the progression of Barrett's esophagus to esophageal adenocarcinoma. Therefore, careful surveillance biopsies remain necessary. A high-quality white light endoscopy examination, using high definition endoscopes, is still the best method to target biopsy the high-risk appearing areas of Barrett's esophagus.
Unfortunately, advanced esophageal adenocarcinoma is often found at the first recognition of BE. If nodular-appearing mucosa are identified in the Barrett's segment, then endoscopic resection of the most abnormal appearing area is essential for proper T staging. Endoscopic ablation therapy is the primary treatment of high-grade dysplasia and T1a esophageal adenocarcinoma. Accompanying endoscopic ultrasound and body imaging are needed for disease deeper than T1a; such disease requires surgical intervention. With limited distal esophageal cancer, a local resection may be possible. For more extensive disease, chemoradiation may be appropriate, followed by definitive surgery. Medical therapy controlling gastroesophageal reflux symptoms with proton pump inhibitors is the background for the above interventions. An ideal approach to neoplasia in Barrett's esophagus would be chemoprevention but, unfortunately, no intervention has yet been documented to be effective in a large clinical trial.
Ultimately, better risk stratification, more effective biomarker predictability of progression to neoplasia, and effective chemoprevention remain key goals for patients with esophageal cancer and Barrett's esophagus.
As editors, we hope that you will find this book comprehensive, intellectually stimulating and helpful in the clinical care of patients with this disease.