Lekakos L, Karidis NP, Dimitroulis D, Tsigris C, Kouraklis G, Nikiteas N. Barrett's esophagus with high-grade dysplasia: Focus on current treatment options. World J Gastroenterol 2011; 17(37): 4174-4183 [PMID: 22072848 DOI: 10.3748/wjg.v17.i37.4174]
Corresponding Author of This Article
Nikolaos P Karidis, MD, General Surgeon, Second Propedeutic Department of Surgery, University of Athens, General Hospital Laiko, Athens 11527, Greece. npkaridis@gmail.com
Article-Type of This Article
Review
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Leonidas Lekakos, Nikolaos P Karidis, Dimitrios Dimitroulis, Christos Tsigris, Gregory Kouraklis, Nikolaos Nikiteas, Second Propedeutic Department of Surgery, Medical School, University of Athens, General Hospital Laiko, Athens 11527, Greece
Christos Tsigris, First Department of Surgery, Medical School, University of Athens, General Hospital Laiko, Athens 11527, Greece
Author contributions: Lekakos L and Karidis NP organized and prepared the draft of the present review; Karidis NP and Dimitroulis D contributed to reference collection and final preparation of the manuscript; Tsigris C, Kouraklis G and Nikiteas N coordinated and reviewed the manuscript.
Correspondence to: Nikolaos P Karidis, MD, General Surgeon, Second Propedeutic Department of Surgery, University of Athens, General Hospital Laiko, Athens 11527, Greece. npkaridis@gmail.com
Telephone: +30-210-9350100 Fax: +30-210-7791456
Received: December 12, 2010 Revised: April 21, 2011 Accepted: April 28, 2011 Published online: October 7, 2011
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.
