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Dig Endosc. 2019 Mar 20. doi: 10.1111/den.13402. [Epub ahead of print]

Challenges to diagnostic standardization of Barrett's esophagus in Asia.

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Department of Gastroenterology and Hepatology, National University Hospital, Singapore.
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia.
Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, USA.
Gastroenterology, University of Kansas, School of Medicine, Kansas City, USA.


Barrett's esophagus (BE), a premalignant condition of the lower esophagus, is increasingly prevalent in Asia. However, endoscopic and histopathological 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 used, different definitions of gastroesophageal junction used across geographical regions and the clinical implications of intestinal metaplasia 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 problems, but further studies are required before implementation into routine clinical practice. The Asian Barrett's Consortium also outlines its ongoing plans to tackle the challenge of standardizing the diagnosis of BE in Asia.


Asia; Barrett's esophagus; columnar-lined esophagus; gastroesophageal junction; intestinal metaplasia


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