Endoscopic Treatment of High-Grade Dysplasia and Early Esophageal Cancer

Francisco Schlottmann, Marco G. Patti, Nicholas J. Shaheen

Research output: Contribution to journalArticle

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Abstract

Background: 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. Aim: The aim of this study was to review the available evidence of the endoscopic treatment of HGD and early esopahgeal adenocarcinoma. Results: 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. Conclusion: 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.

LanguageEnglish (US)
Pages1705-1711
Number of pages7
JournalWorld Journal of Surgery
Volume41
Issue number7
DOIs
StatePublished - Jul 1 2017

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Esophageal Neoplasms
Barrett Esophagus
Adenocarcinoma
Metaplasia
Therapeutics
Neoplasms

ASJC Scopus subject areas

  • Surgery

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Endoscopic Treatment of High-Grade Dysplasia and Early Esophageal Cancer. / Schlottmann, Francisco; Patti, Marco G.; Shaheen, Nicholas J.

In: World Journal of Surgery, Vol. 41, No. 7, 01.07.2017, p. 1705-1711.

Research output: Contribution to journalArticle

Schlottmann, Francisco ; Patti, Marco G. ; Shaheen, Nicholas J. / Endoscopic Treatment of High-Grade Dysplasia and Early Esophageal Cancer. In: World Journal of Surgery. 2017 ; Vol. 41, No. 7. pp. 1705-1711.
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