Esophageal adenocarcinoma (EAC) is an often deadly cancer with an incidence in Western countries that has continued to rise in the past few decades.1,2 In 2004, 8000 incidences of EAC occurred in the United States, representing a 2- to 6-fold increase in the past 20 years.3 In general, EAC affects Caucasian men (men are affected 6 to 8 times > women, and Caucasians 3 to 4 times > African-Americans) in their 50s to 60s, with an annual increase of 4% to 10% since the 1970s, making EAC the fastest rising malignancy among white men in the United States.2,4,5 Risk factors include both genetic and environmental factors, including central obesity, smoking, and diet.2,6 The 5-year survival rate for esophageal and gastroesophageal junction cancers is low at only 15% to 20%.7
Chronic gastroesophageal reflux disease is associated with the metaplastic transformation of normal squamous epithelium to specialized intestinal metaplasia within the esophagus (Barrett's esophagus).1 This premalignant condition of Barrett's esophagus can progress to low-grade dysplasia (LGD) or high-grade dysplasia (HGD), and in some cases to EAC.8 Gastroesophageal reflux disease affects approximately 20% of adults in the United States,9 with Barrett's esophagus diagnosed in 10% to 15% of these patients with reflux disease who undergo endoscopy, and 5.6% of patients without chronic reflux symptoms.10 However, patients without chronic reflux may also develop Barrett's esophagus, suggesting the presence of multiple associated risk factors.11 Currently, Barrett's esophagus is the only recognized pathologic precursor to EAC.12 Barrett's esophagus is associated with a 0.50% to 0.75% risk of progressing to EAC per year, with the greatest risk in patients with dysplastic Barrett's. Because esophagectomy may be associated with significant morbidity, endoscopic therapies for premalignant Barrett's esophagus and early EAC have been developed and studied.
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