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JOURNAL ARTICLE
REVIEW

Challenges to Diagnostic Standardization of Barrett's Esophagus in Asia

Yu Sen Alex Soh, Yeong Yeh Lee, Takuji Gotoda, Prateek Sharma, Khek-Yu Ho, Asian Barrett's Consortium
Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society 2019 March 20
30892742
Barrett's Esophagus (BE), a premalignant condition of the lower esophagus, is increasingly prevalent in Asia. However, endoscopic and histopathogical criteria vary widely between studies across Asia, making it challenging to assess comparability between geographical regions. Furthermore, guidelines from various societies worldwide provide differing viewpoints and definitions, leading to diagnostic challenges that affect prognostication of the condition. In this review, the authors discuss the controversies surrounding the diagnosis of BE, particularly in Asia. Differences between guidelines worldwide are summarized with further discussion regarding various classifications of BE employed, different definitions of gastroesophageal junction used across geographical regions and the clinical implications of Intestinal Metaplasia (IM) in the setting of BE. Although many guidelines recommend the Seattle protocol as the preferred approach regarding dysplasia surveillance in BE, some limitations exist, leading to poor adherence. Newer technologies, such as acetic acid-enhanced magnification endoscopy, narrow band imaging, Raman spectroscopy, molecular approaches and the use of artificial intelligence appear promising in addressing these issues, but further studies are required before implementation into routine clinical practice. Moving forward, the Asian Barrett's Consortium also outlines its ongoing plans to tackle the challenge of standardizing the diagnosis of BE in Asia. This article is protected by copyright. All rights reserved.

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