Patients with Barrett's esophagus where squamous esophageal epithelium has been replaced by columnar epithelium containing goblet cells have an increased risk of esophageal adenocarcinoma. Unfortunately, most of those adenocarcinomas are detected at an advanced stage in which they are incurable. Many biomarkers have been studied, trying to identify the subset of patients who are at very high risk for adenocarcinoma. Dysplasia is at present the for the risk of adenocarcinoma. However, overexpression of p53, allelic losses, proliferation indices, flow cytometric abnormalities, accumulation of acidic fibroblast growth factor, expression of blood group antigens and sucrase-isomaltase during the Barrett's to adenocarcinoma sequence appear promising. However, additional information is needed to justify routine application in clinical practice and to define their role in surveillance programs.
This work was supported by grant 94-715 from the Dutch Cancer Society.