**4. Management**

BE is not always associated with dysplasia. According to the latest recommendations, if a patient with BE is diagnosed and if the last two endoscopic examinations with biopsy have confirmed the absence of dysplasia, then the patient should have the next endoscopy within 3 years [3, 10, 14].

The risk of malignancy is highest in the United States in Caucasian men over 50 years of age with more than 5 years of symptoms. Although watchful waiting is preferred in cases of BE, for cases with dysplasia, balloon-based radiofrequency ablation, invented by Ganz, Stern, and Zelickson in 1999, is a new treatment modality for the treatment of BE and dysplasia and has been the subject of numerous published clinical trials. The findings demonstrate radiofrequency ablation has an efficacy of 90% or greater with respect to complete clearance of BE and dysplasia with the durability of up to 5 years and a favorable safety profile [15–18].

The results of antireflux surgery, specifically fundoplication, have not been proven to prevent esophageal cancer. Proton pump inhibitors have been shown to be effective in limiting the progression of esophageal cancer. Laser treatment is used in severe dysplasia, while open malignancy may require surgery, radiation therapy, or systemic chemotherapy. A recent 5-year study randomly showed that photodynamic therapy using photofrin is statistically more effective in eliminating dysplastic foci than the use of a proton pump inhibitor alone [19].

The heterogeneous nature of Barrett's explains the wide spectrum of the degree of mutational overlap between adjacent BE and eopphageal adenocarcinoma [20].

Anti-reflux surgery (ARS), namely laparoscopic fundoplication, is the last step in GERD management. Its objectives are LES, basal pressure increase and hiatal repair [21].
