title: Endoscopic Treatment of High-Grade Dysplasia and Early Esophageal Cancer.
abstract: The emergence of novel endoscopic modalities has challenged the role of surgery for patients with Barrett's esophagus (BE) and high-grade dysplasia (HGD) or early esophageal adenocarcinoma.
  
  
  
  The aim of this study was to review the available evidence of the endoscopic treatment of HGD and early esopahgeal adenocarcinoma.
  
  
  
  For most patients with BE and HGD, endoscopic ablative therapy is the preferred treatment strategy. Patients with intramucosal adenocarcinoma (T1a) should be treated with endoscopic mucosal resection (EMR) followed by ablative therapy, in order to eradicate the remaining intestinal metaplasia. The best approach to treatment of adenocarcinoma with submucosal invasion (T1b) remains elusive. Endoscopic resection may be suitable for low-risk T1b tumors (well differentiated, without lymphovascular invasion and with superficial submucosal invasion); however, further data are necessary to better risk stratify this group. Careful endoscopic surveillance is recommended following complete eradication of intestinal metaplasia to detect recurrent disease.
  
  
  
  Patients with BE and HGD should undergo endoscopic ablative therapy. Patients with T1a adenocarcinoma should be treated with EMR and subsequent ablation of the entire BE segment. Low-risk T1b tumors may be suitable for endoscopic resection.
authors.affiliation: Department of Surgery and Center for Esophageal Diseases and Swallowing, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Francisco
authors.initials: F
authors.lastname: Schlottmann
authors.affiliation: Department of Surgery and Center for Esophageal Diseases and Swallowing, University of North Carolina, Chapel Hill, NC, USA.|Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, CB#7080, Chapel Hill, NC, 27599-7080, USA.
authors.forename: Marco G
authors.initials: MG
authors.lastname: Patti
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, CB#7080, Chapel Hill, NC, 27599-7080, USA. nshaheen@med.unc.edu.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Shaheen
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D001471:Barrett Esophagus / Q000601:surgery; D017115:Catheter Ablation; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology*; D006801:Humans; D008679:Metaplasia; D011230:Precancerous Conditions / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*