title: An analysis of esophagectomy and other techniques in the management of high-grade dysplasia of Barrett's esophagus.
abstract: Barrett's esophageal (BE) metaplasia is a premalignant condition of the distal esophagus that develops as a consequence of gastroesophageal reflux disease. The progression to carcinogenesis results from progressive dysplastic changes of the metaplastic epithelium through low-grade and then high-grade dysplasia (HGD) to eventually adenocarcinoma of the esophagus. The management of HGD is controversial with proponents for each of the three major management strategies: endoscopic surveillance, endoscopic ablative therapies, and esophagectomy. The aim of the study was to define and discuss the various management strategies of HGD arising from BE metaplasia. There is a paucity of randomized controlled data from which to draw definitive conclusions. All strategies for the management of HGD are reasonable options and are complimentary. BE with HGD is a malignant lesion. A multidisciplinary approach individualizing therapy should be undertaken when possible. Esophageal resection should be reserved for otherwise healthy patients. Endoscopic techniques are viable alternatives to surgery.
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic College of Medicine, Rochester, MN 50501, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Deb
authors.forename: K R
authors.initials: KR
authors.lastname: Shen
authors.forename: C
authors.initials: C
authors.lastname: Deschamps
mesh_terms: D001471:Barrett Esophagus / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation; D004564:Electrocoagulation; D016629:Esophagectomy / Q000009:adverse effects; D004945:Esophagoscopy; D006801:Humans; D009092:Mucous Membrane / Q000601:surgery; D010778:Photochemotherapy; D011159:Population Surveillance; D011230:Precancerous Conditions / Q000473:pathology / Q000628:therapy*