title: Low grade dysplasia in Barrett's esophagus: Should we worry?
abstract: The optimal management for low-grade dysplasia (LGD) in Barrett's esophagus is unclear. In this article the importance of LGD is discussed, including the significant risk of progression to esophageal adenocarcinoma. Endoscopic surveillance is a management option but is plagued by sampling error and issues of suboptimal endoscopy. Furthermore endoscopic surveillance has not been demonstrated to be cost-effective or to reduce cancer mortality. The emergence of endoluminal therapy over the past decade has resulted in a paradigm shift in the management of LGD. Ablative therapy, including radiofrequency ablation, has demonstrated promising results in the management of LGD with regards to safety, cost-effectiveness, durability and reduction in cancer risk. It is, however, vital that a shared-decision making process occurs between the physician and the patient as to the preferred management of LGD. As such the management of LGD should be "individualised."
authors.affiliation: Vamshi P Jagadesham, Clive J Kelty, Department of Upper Gastrointestinal Surgery, Northern General Hospital, Sheffield S5 7AU, United Kingdom.
authors.forename: Vamshi P
authors.initials: VP
authors.lastname: Jagadesham
authors.affiliation: Vamshi P Jagadesham, Clive J Kelty, Department of Upper Gastrointestinal Surgery, Northern General Hospital, Sheffield S5 7AU, United Kingdom.
authors.forename: Clive J
authors.initials: CJ
authors.lastname: Kelty
keywords: Barrett’s esophagus; Endoluminal therapy; Esophageal adenocarcinoma; Low grade dysplasia; Radiofrequency ablation