Open AccessBarrett's esophagus with high-grade dysplasia: Focus on current treatment options
Author(s) -
Leonidas Lekakos,
Nikolaos P. Karidis,
Dimitrios Dimitroulis,
Christos Tsigris,
Gregory Kouraklis,
Nikolaos Nikiteas
Publication year - 2011
Publication title -
world journal of gastroenterology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.427
H-Index - 155
eISSN - 2219-2840
pISSN - 1007-9327
DOI - 10.3748/wjg.v17.i37.4174
Subject(s) - medicine , esophagectomy , esophagus , dysphagia , dysplasia , hiatal hernia , natural history , barrett's esophagus , endoscopic mucosal resection , surgery , endoscopy , reflux , adenocarcinoma , general surgery , gastroenterology , esophageal cancer , disease , cancer
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.