Diagnostic Conundrums of Gastroesophageal Junctional Adenocarcinoma and Barrett Esophagus in Asia

The overall trend indicates a similar or gradually increasing prevalence of gastroesophageal junctional (GEJ) adenocarcinoma and Barrett esophagus across countries in Asia, but comparably less than the West. The rising trend is likely a result of gastroesophageal reflux disease and obesity. However, epidemiology data may be misleading due to several contentious diagnostic issues. The diagnostic conundrums are due to the inherent complexity of the GEJ as a functional and pathological unit. These conundrums include non-standardized landmark of the GEJ, misclassification of Barrett esophagus (BE), targeted vs. non-targeted tissue sampling, histopathology disagreement, and challenges in screening or surveillance of dysplastic BE and early GEJ cancer. The recent Asian-Pacific survey led by the Asian Barrett Consortium (ABC) has provided useful insights into these contentious issues. Among key points include poor awareness of the disease and adherence to existing recommendations or guidelines in the region. Thus, standardization in diagnostic methodology is vital for accurate epidemiology data, and this can only come from increasing educational and international efforts. Lastly, surveillance strategy may need a paradigm shift from a purely diagnostic approach to a combined targeted surveillance and treatment approach using novel endoscopic techniques.