Endoscopic treatment of high-grade dysplasia and early cancer in Barrett's oesophagus.
Barrett's oesophagus is the premalignant precursor of oesophageal adenocarcinoma. Non-dysplastic metaplasia can progress to low-grade dysplasia, high-grade dysplasia, and finally to invasive cancer. Although the frequency of adenocarcinoma in patients with Barrett's oesophagus is low, surveillance is justified because the outcome of adenocarcinoma is poor. Oesophagectomy remains the standard treatment for patients with high-grade dysplasia and superficial carcinoma. However, it has been associated with substantial morbidity and mortality and some patients are judged unfit for surgery. In this review, the present status of less invasive procedures is discussed. Endotherapy preserves the integrity of the oesophagus and allows a better quality of life to patients at low risk of developing lymph-node metastases. Opposition to endoscopic treatment is based mainly on the identification of undetected foci of cancer and high-grade dysplasia in oesophagectomy samples. The current ablative techniques used are photodynamic therapy, argon plasma coagulation, laser treatment, and endoscopic mucosal resection.
Conio
Massimo
M
Department of Gastroenterology, Sanremo Hospital, Sanremo, Italy. mxconio@tin.it <mxconio@tin.it>
Cameron
Alan J
AJ
Chak
Amitabh
A
Blanchi
Sabrina
S
Filiberti
Rosangela
R
D000230:Adenocarcinoma / Q000175:diagnosis; D001471:Barrett Esophagus / Q000000981:diagnostic imaging / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000175:diagnosis; D016629:Esophagectomy; D004945:Esophagoscopy / Q000379:methods*; D005453:Fluorescence; D006801:Humans; D017075:Laser Coagulation; D010778:Photochemotherapy; D011230:Precancerous Conditions / Q000628:therapy*; D014463:Ultrasonography