Esophageal resection for high-grade dysplasia and intramucosal carcinoma: When and how?

Table 1 High-risk characteristics associated with submucosal invasion, lymph node metastasis, or unsuccessful endoscopic therapy

Endoscopic characteristics

Long-segment Barrett’s esophagus

Visible lesions with high risk endoscopic characteristics

Polypoid mass

Excavated lesions or ulcers

Evidence of lymph node involvement by EUS + FNA

Pathological characteristics

Multifocal HGD

Evidence of submucosal invasion

Deeper two thirds of the submucosa carries high risk of lymph node metastasis

Moderately or poorly differentiated tumor

Evidence of lymphatic channel invasion

Evidence of vascular invasion

Evidence of neural invasion

Treatment characteristics

Failure of ablation of remainder for Barrett’s epithelium

Piecemeal endoscopic resection (as opposed to en bloc resection)

Longer time to achieve eradication

EUS: Endoscopic ultrasound; FNA: Fine needle aspiration; HGD: High-grade dysplasia.