Chapter 52

Barrett Esophagus and Esophageal Adenocarcinoma

Stuart Jon Spechler

Stuart Jon Spechler

The University of Texas Southwestern Medical Center, Dallas, TX, USA

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David H. Wang

David H. Wang

The University of Texas Southwestern Medical Center, Dallas, TX, USA

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Rhonda F. Souza

Rhonda F. Souza

The University of Texas Southwestern Medical Center, Dallas, TX, USA

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First published: 27 November 2015

Summary

Barrett esophagus is the condition in which a metaplastic columnar epithelium that predisposes to cancer replaces the stratified squamous epithelium that normally lines the distal esophagus. For patients with verified high-grade dysplasia in Barrett esophagus, three management options have been proposed: intensive endoscopic surveillance in which invasive therapies are withheld until biopsy specimens reveal adenocarcinoma; esophagectomy; and endoscopic eradication therapy. This chapter summarizes that esophagectomy for early neoplasia in Barrett esophagus definitively removes all of the esophagus at increased risk for malignancy, provides a specimen that can be examined for evidence of invasion and obviates the concern that local lymph nodes might contain metastases. Multiple studies have demonstrated the added survival benefit of adding chemotherapy or chemoradiation to surgical resection in patients with esophageal cancer. The chapter reviews the clinical trials that support definitive chemoradiation, neoadjuvant chemotherapy and chemoradiation, perioperative chemotherapy, and adjuvant chemotherapy and chemoradiation.

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