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Latest developments will "dramatically change" the management of Barrett’s oesophagus and oesophageal cancer

Stockholm, 24th October 2011

The results of several major studies assessing novel approaches to the detection and treatment of Barrett’s oesophagus and oesophageal cancer will be presented at this year’s United European Gastroenterology Week (UEGW) in Stockholm, Sweden. According to Professor Jacques Bergman from the Academic Medical Centre in Amsterdam, Netherlands, speaking to journalists at a UEGW press conference at the meeting, these results will have a major impact on the way patients are diagnosed and managed in the future. “Some of the finest research in the field of oesophageal cancer and the management of Barrett’s oesophagus is being presented at this meeting,” he said. “This research will dramatically change the way we screen for Barrett’s patients, the way we identify those at risk of progressing to cancer, and the way we treat early cancers in these patients.”

What is Barrett’s oesophagus?

Barrett’s oesophagus is a condition that affects the lower section of the oesophagus nearest the stomach. The cells (squamous cells) lining this part of the oesophagus gradually change and become more like those lining the stomach (columnar cells) – usually as a result of the long-term reflux of stomach acid into the oesophagus. Although the changed cells of Barrett’s oesophagus are not cancerous, they are at increased risk of turning cancerous over time, leading eventually to oesophageal adenocarcinoma.

According to Prof. Bergman, while still relatively rare, the incidence of oesophageal adenocarcinoma has increased six-fold in the last 40 years – an increase unsurpassed by any other cancer in the Western world. “Unfortunately, most oesophageal cancers are still diagnosed at an advanced stage where the prognosis is extremely poor,” he told journalists.

New developments in surveillance

Most patients diagnosed with Barrett’s oesophagus undergo regular endoscopic surveillance in order to detect early cancerous cell changes (neoplasia) at a curable stage. The problem, said Prof. Bergman, is that most Barrett’s patients remain undiagnosed and are not part of a surveillance programme. Large-scale endoscopic screening for Barrett’s oesophagus is not considered cost-effective and is associated with a relatively low yield, since the annual cancer progression rate is as low as 0.5%. “However,” said Prof. Bergman, “recent developments in this field, such as the use of trans-oral sponge cytology and molecular markers for cancer progression, open the very real possibility of large-scale and cost-effective screening for Barrett’s oesophagus in patients with known risk factors for this condition (e.g. white ethnicity, older age, obesity, and long duration of gastro-oesophageal reflux disease symptoms such as heartburn).”

Trans-oral sponge cytology is a new technique that involves swallowing a small “sponge” attached to a string – called a Cytosponge. The sponge collects cell specimens from the Barrett’s region of the oesophagus and is withdrawn using the string for laboratory processing. “This allows the detection of Barrett’s patients without the need for endoscopy and has the potential to identify individuals who otherwise might progress to advanced cancer, with a chance of early diagnosis by endoscopic means,” he added.

A variety of molecular markers for Barrett’s cells at risk of progressing to oesophageal cancer are also under investigation. According to Prof. Bergman, these markers can be found in brush cytology specimens from Barrett’s segments, thus reducing the sampling errors that are inevitably associated with biopsies. “Patients at risk might then be treated prophylactically, whereas surveillance may be stopped altogether in low-risk individuals,” he explained. “Although these tools are not yet commercially available, they are expected to change the management of Barrett’s patients considerably in the near future.”

New developments in treatment

Cancer of the oesophagus has traditionally been treated by removal of the oesophagus, which is a major and complex procedure that is frequently associated with serious complications. Newer treatments such as laser therapy, photodynamic therapy, radiofrequency ablation and endoscopic resection are designed to remove just the abnormal cells from the lining of the oesophagus – thus sparing the oesophagus.

“Multicentre European studies show that the treatment of early neoplasia in Barrett’s using a combination of endoscopic resection and radiofrequency ablation results in the complete removal of the Barrett’s segment in almost all patients,” said Prof. Bergman. “The final results of a major European study on the endoscopic treatment of Barrett’s-associated neoplasia are being presented at this meeting and the results are truly spectacular.”

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