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Barrett's esophagus with high-grade dysplasia: focus on current treatment options.

Authors
Type
Published Article
Journal
World Journal of Gastroenterology
1007-9327
Publisher
Baishideng Publishing Group Co
Publication Date
Volume
17
Issue
37
Pages
4174–4183
Identifiers
DOI: 10.3748/wjg.v17.i37.4174
PMID: 22072848
Source
Medline
Keywords
License
Unknown

Abstract

High-grade dysplasia (HGD) in Barrett's esophagus (BE) is the critical step before invasive esophageal adenocarcinoma. Although its natural history remains unclear, an aggressive therapeutic approach is usually indicated. Esophagectomy represents the only treatment able to reliably eradicate the neoplastic epithelium. In healthy patients with reasonable life expectancy, vagal-sparing esophagectomy, with associated low mortality and low early and late postoperative morbidity, is considered the treatment of choice for BE with HGD. Patients unfit for surgery should be managed in a less aggressive manner, using endoscopic ablation or endoscopic mucosal resection of the entire BE segment, followed by lifelong surveillance. Patients eligible for surgery who present with a long BE segment, multifocal dysplastic lesions, severe reflux symptoms, a large fixed hiatal hernia or dysphagia comprise a challenging group with regard to the appropriate treatment, either surgical or endoscopic.

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