What's new in columnar lined esophagus (Barrett's metaplasia)?

Purpose of review The rising incidence of esophageal adenocarcinoma in the Western world has led to continued interest in its precursor lesion, Barrett's esophagus. This review endeavors to summarize the recent advances in our understanding of Barrett's esophagus with an emphasis on novel imaging techniques and endoscopic therapies. Recent findings There are indications that ethnic minorities such as blacks and Hispanics are at considerably lower risk for Barrett's esophagus (<2%) compared with whites. Central obesity rather than BMI could be a more important determinant of Barrett's metaplasia and neoplasia. Novel imaging techniques, in feasibility trials, have shown high accuracy for the detection of metaplasia and dysplasia. Finally, a much lower prevalence of concomitant occult invasive cancer among high-grade dysplasia patients undergoing esophagectomy and similar long-term survival in endoscopically versus surgically treated high-grade dysplasia patients has led to a shift in treatment algorithms favoring endoscopic therapy. Summary A better appreciation of risk factors that lead to Barrett's esophagus and its neoplastic progression may help in formulating early intervention strategies. The emergence of novel imaging modalities for early and accurate detection of dysplasia, combined with new therapies, may have a substantial impact in improving outcomes among Barrett's esophagus patients.