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Barrett's esophagus and cancer risk: how research advances can impact clinical practice.
[esophageal adenocarcinoma]
Barrett
's
esophagus
(
BE
)
is
the
only
known
precursor
to
esophageal
adenocarcinoma
(
EAC
)
,
whose
incidence
has
increased
sharply
in
the
last
4
decades
.
The
annual
conversion
rate
of
BE
to
cancer
is
significant
,
but
small
.
The
identification
of
patients
at
a
higher
risk
of
cancer
therefore
poses
a
clinical
conundrum
.
Currently
,
endoscopic
surveillance
is
recommended
in
BE
patients
,
with
the
aim
of
diagnosing
either
dysplasia
or
cancer
at
early
stages
,
both
of
which
are
curable
with
minimally
invasive
endoscopic
techniques
.
There
is
a
large
variation
in
clinical
practice
for
endoscopic
surveillance
,
and
dysplasia
as
a
marker
of
increased
risk
is
affected
by
sampling
error
and
high
interobserver
variability
.
Screening
programs
have
not
yet
been
formally
accepted
,
mainly
due
to
the
economic
burden
that
would
be
generated
by
upper
gastrointestinal
endoscopy
.
Screening
programs
have
not
yet
been
formally
accepted
,
mainly
due
to
the
economic
burden
that
would
be
generated
by
widespread
indication
to
upper
gastrointestinal
endoscopy
.
In
fact
,
it
is
currently
difficult
to
formulate
an
accurate
algorithm
to
confidently
target
the
population
at
risk
,
based
on
the
known
clinical
risk
factors
for
BE
and
EAC
.
This
review
will
focus
on
the
clinical
and
molecular
factors
that
are
involved
in
the
development
of
BE
and
its
conversion
to
cancer
and
on
how
increased
knowledge
in
these
areas
can
improve
the
clinical
management
of
the
disease
.
Diseases
Validation
Diseases presenting
"known clinical risk factors"
symptom
esophageal adenocarcinoma
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