Charles J. Lightdale, MD, Consulting Editor

The past two decades have seen improvements in endoscopic diagnosis of Barrett’s esophagus and in identification of dysplasia in Barrett’s mucosa. At the same time, there has been remarkable progress in endoscopic therapies that can effectively and safely eradicate Barrett’s tissue at high risk of progression to cancer. While this progress is impressive, there remain many questions and controversies in the management of Barrett’s esophagus. These are presented and discussed in detail in this issue of Gastrointestinal Endoscopy Clinics of North America devoted to new directions in Barrett’s esophagus. Dr Nicholas Shaheen, the editor for the issue, is widely recognized for his dynamic leadership in this area, and his research has had a major impact on how Barrett’s patients are treated. He has selected an all-star international group of authors who present a comprehensive state-of-the art review with a look to the future.

The foundation of the issue is the first article on the epidemiology of Barrett’s esophagus and esophageal adenocarcinoma. Since more than 90% of patients with esophageal adenocarcinoma present at the time of diagnosis with usually lethal advanced stage cancer and have never been diagnosed previously with Barrett’s esophagus, the need to screen patients for Barrett’s esophagus comes to the fore. The important questions of who to screen and how to screen are discussed in following articles, including new nonendoscopic screening methods. Cost-effectiveness of screening and surveillance is covered as well as the place of advanced imaging methods and the role of biomarkers in cancer risk stratification in patients with Barrett’s esophagus. The fine points of endoscopic mucosal resection and endoscopic submucosal dissection, the use of endoscopic ultrasonography for staging, the impact of radiofrequency ablation, and the emergence of cryoablation are other topics. How to follow and manage patients after complete eradication of dysplasia and intestinal metaplasia for possible recurrence and the role of surgery for esophageal adenocarcinoma are additional important subjects given detailed review.

Jam-packed with information on the management of Barrett’s esophagus and the prevention of esophageal adenocarcinoma, this is a terrific issue of Gastrointestinal Endoscopy Clinics of North America . Don’t miss it!