Multipolar electrocoagulation

An analysis of esophagectomy and other techniques in the management of high-grade dysplasia of Barrett's esophagus

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.

Barrett's esophagus and the increasing role of endoluminal therapy

Barrett's esophagus, or the presence of specialized intestinal mucosa in the esophagus that has a malignant potential, has experienced a rapid increase in diagnosis and prevalence over the past few decades. Once thought to progress to adenocarcinoma in an orderly sequence of increasing dysplasia, recent data suggest the process can be more random. In combination with targeted surveillance endoscopy, recent improvements in technology have aided endoluminal therapy in becoming a cost-effective adjunct to medication. When used in combination, in particular, these ablative therapies have become suitable, if not preferable, alternatives to surgery in many patients.