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Optimal Management of Barrett Esophagus with High Grade Dysplasia

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Difficult Decisions in Thoracic Surgery

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Abstract

The incidence of esophageal adenocarcinoma has risen by six-fold proportions from 1975 to 2001 within the United States.1 Barrett esophagus (BE) with biopsy-proven high-grade dysplasia (HGD) is the strongest risk factor for progression to carcinoma.2 Traditionally, this condition has been managed by esophagectomy, due to the concern of occult malignancy, estimated at approximately 40%.3,4 However, a more recent systematic literature analysis found that, although the frequency of occult cancer occurring within esophagectomy specimens in patients with HGD is about 39.9%, most of these patients had superficial cancers limited to the mucosa. In fact, the rate of invasive cancer, defined by at least submucosal invasion, was only 12.7%.5 Esophagectomy has also traditionally performed for BE with intramucosal carcinoma (IMC), despite a relatively low incidence of lymph node metastasis (less than 1%) associated with, T1a (non-invasive) disease.6,7 Additionally, the morbidity and mortality of esophagectomy are still significant even in high volume centers, a factor that should be considered when selecting therapy for a disease that may be cured with less aggressive therapy.8,9

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Authors and Affiliations

  1. Section of Gastroenterology, The University Chicago, Chicago, IL, USA

    Jennifer S. Chennat

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  1. Jennifer S. Chennat
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  1. Dept. Surgery, Mail Code 5035, University of Chicago, S. Maryland Avenue 5841, Chicago, 60637, Illinois, USA

    Mark K. Ferguson

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Chennat, J.S. (2011). Optimal Management of Barrett Esophagus with High Grade Dysplasia. In: Ferguson, M. (eds) Difficult Decisions in Thoracic Surgery. Springer, London. https://doi.org/10.1007/978-1-84996-492-0_22

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  • DOI: https://doi.org/10.1007/978-1-84996-492-0_22

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