UPDATES IN THE APPROACH TO BARRETT’S METAPLASIA: A SYNTHESIS OF CLINICAL AND TECHNOLOGICAL PROGRESS IN 2025

Abstract

Background. In recent years, research on the diagnostic and curative potential of metaplastic esophageal mucosa (gastric/intestinal) has advanced significantly. Artificial Intelligence (AI) -assisted endoscopy, the significant predictive value of molecular biomarkers, and endoablations combined with immunotherapy have improved both early diagnosis and the stratification of the risk of progression to esophageal adenocarcinoma (EAC).

Objective. The objective of this paper is to analyze, synthesize, and assess the impact of the latest medical innovations in the diagnosis and treatment of Barrett's esophagus (BE) that have emerged over the last five years.

Material and methods. The study was conducted by accessing the PubMed, Scopus, Embase, Cochrane, and Google Scholar databases, using syntax consisting of the following keywords: Barrett's esophagus, esophageal adenocarcinoma, endoscopic diagnosis, endoscopic treatment, ablation, minimally invasive surgery, artificial intelligence. The search was restricted to English-language scientific publications, published between 2022 and 2025.

Results. Thus, it was found that regarding diagnosis, Barrett's esophagus features new methods and strategies: confocal endomicroscopy, non-invasive tests (Cytosponge-TFF3, which is a minimally invasive test validated for Barrett's screening), molecular biomarkers (TP53, epigenetic (VIM, NELL1, CDKN2A), microRNA (miR-21, miR-215)), and Artificial Intelligence (AI systems integrated into endoscopy visually detect dysplasia, and when associated with biomarkers, represent a personalized prediction tool for neoplasia risk). In the context of treating esophageal metaplasia, Radiofrequency Ablation (RFA) remains the standard for high-grade dysplasia (HGD) and uncomplicated Barrett's esophagus, while endoscopic mucosectomy and endoscopic mucosal resection (EMR) are used for focal lesions or suspected early neoplasia. Ablative endoscopic treatments (radiofrequency, cryotherapy) and segmental endoscopic resections (EMR, endoscopic submucosal dissection (ESD)) have largely replaced radical surgery in the early stages of this pathology. Meanwhile, laparoscopic antireflux surgery and hybrid approaches (endoluminal-surgical) maintain their role in the complex management of refractory or recurrent cases, as well as serving as a step in resolving the etiopathogenetic link of the disease.

Conclusions: The diagnosis of Barrett's esophagus is becoming increasingly non-invasive and molecular (salivary/epigenetic testing + AI), and treatment is becoming more personalized through risk stratification, AI-guided ablations, and alternative methods to RFA. Thus, a transition is emerging from a universal approach to precision medicine in Barrett's esophagus.