title: Barrett's esophagus with high-grade dysplasia: focus on current treatment options.
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.
authors.affiliation: Second Propedeutic Department of Surgery, Medical School, University of Athens, General Hospital Laiko, Athens 11527, Greece.
authors.forename: Leonidas
authors.initials: L
authors.lastname: Lekakos
authors.forename: Nikolaos P
authors.initials: NP
authors.lastname: Karidis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Dimitroulis
authors.forename: Christos
authors.initials: C
authors.lastname: Tsigris
authors.forename: Gregory
authors.initials: G
authors.lastname: Kouraklis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Nikiteas
mesh_terms: D001471:Barrett Esophagus / Q000209:etiology / Q000473:pathology* / Q000628:therapy*; D017115:Catheter Ablation; D016629:Esophagectomy; D004945:Esophagoscopy; D005764:Gastroesophageal Reflux / Q000150:complications / Q000473:pathology / Q000628:therapy; D006801:Humans; D010778:Photochemotherapy; D011230:Precancerous Conditions / Q000473:pathology* / Q000628:therapy*
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