Review
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Oct 7, 2011; 17(37): 4174-4183
Published online Oct 7, 2011. doi: 10.3748/wjg.v17.i37.4174
Barrett's esophagus with high-grade dysplasia: Focus on current treatment options
Leonidas Lekakos, Nikolaos P Karidis, Dimitrios Dimitroulis, Christos Tsigris, Gregory Kouraklis, Nikolaos Nikiteas
Leonidas Lekakos, Nikolaos P Karidis, Dimitrios Dimitroulis, Christos Tsigris, Gregory Kouraklis, Nikolaos Nikiteas, Second Propedeutic Department of Surgery, Medical School, University of Athens, General Hospital Laiko, Athens 11527, Greece
Christos Tsigris, First Department of Surgery, Medical School, University of Athens, General Hospital Laiko, Athens 11527, Greece
Author contributions: Lekakos L and Karidis NP organized and prepared the draft of the present review; Karidis NP and Dimitroulis D contributed to reference collection and final preparation of the manuscript; Tsigris C, Kouraklis G and Nikiteas N coordinated and reviewed the manuscript.
Correspondence to: Nikolaos P Karidis, MD, General Surgeon, Second Propedeutic Department of Surgery, University of Athens, General Hospital Laiko, Athens 11527, Greece. npkaridis@gmail.com
Telephone: +30-210-9350100 Fax: +30-210-7791456
Received: December 12, 2010
Revised: April 21, 2011
Accepted: April 28, 2011
Published online: October 7, 2011
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.

Keywords: Barrett’s esophagus; High-grade dysplasia; Endoscopic ablation; Endoscopic excision; Surgical treatment