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Endoscopic management of high-grade dysplasia (HGD) of the esophagus, an alternative to esophagectomy, has risen in popularity over the last decade. Despite this popularity, some patients may benefit from esophagectomy. Guidelines indicating which patients should receive surgery vs. endoscopic treatment are nonexistent. This systematic literature review aims to define the current role of surgery in the treatment of HGD. The current literature is lacking in definitive guidelines for all patients. Patients with nodules, ulcers, multifocal dysplasia, large hiatal hernias, and long segment Barrett’s esophagus should be counseled on the risks and benefits of esophagectomy as first-line treatment. A multidisciplinary approach should be taken to tailor treatment based on patient and disease characteristics.

High-grade dysplasia of the esophagus: when is it time for surgery? —a systematic review