High-grade dysplasia and intramucosal adenocarcinoma in Barrett's esophagus

The role of esophagectomy in the era of endoscopic eradication therapy

Renato A. Luna, Erin Gilbert, John Hunter

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Purpose of review: The aim of this review is to evaluate the role of esophagectomy for high-grade dysplasia (HGD) and intramucosal adenocarcinoma (IMC) in light of recent advances in endoscopic therapy for Barrett's esophagus. Recent findings: Radiofrequency ablation (RFA) and endoscopic mucosal resection (EMR) are proven well tolerated and effective, at least in midterm follow-up. The application of these techniques has opened a new road for the local treatment of esophageal HGD and IMC. To safely employ these techniques, reliable and accurate staging of the esophageal neoplasm is essential. EMR has taken a central role, as it allows the pathologist to provide tumor-staging information necessary for an appropriate clinical management decision process. Unfortunately, both RFA and EMR have limitations that preclude their universal use in the treatment of early esophageal cancer. In some cases, esophagectomy still remains the best treatment option. The evolution of the minimally invasive approach to esophagectomy may improve outcomes of this major operation. Summary: A better understanding of the indications and limitations of endoscopic therapy for HGD and IMC permits a tailored approach to the management of patients with early esophageal adenocarcinoma. When indicated, the selection of a less morbid surgical technique has the potential to improve overall surgical and oncological outcomes.

Original languageEnglish (US)
Pages (from-to)362-369
Number of pages8
JournalCurrent Opinion in Gastroenterology
Volume28
Issue number4
DOIs
StatePublished - Jul 2012

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Esophagectomy
Barrett Esophagus
Adenocarcinoma
Esophageal Neoplasms
Therapeutics
Neoplasm Staging
Endoscopic Mucosal Resection

Keywords

  • Barrett's esophagus
  • early esophageal adenocarcinoma
  • endoscopic ablation
  • endoscopic mucosal resection
  • esophagectomy

ASJC Scopus subject areas

  • Gastroenterology

Cite this

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