[Severe dysplasia in Barrett's esophagus]

Two patients with Barret's esophagus developed severe dysplasia diagnosed during endoscopic surveillance. Both patients underwent esophagectomy. The surgical specimen revealed adenocarcinoma in situ in the first patient and invasive adenocarcinoma to the submucosa in the second one. The life expectancy in these patients is at least 75% at 5 years, much better than the 5% five year survival of the patients diagnosed when they present with dysphagia. The natural history, pathogenesis, diagnosis, treatment and prevention are discussed.