Current practice in management of high-grade dysplasia in Barrett's oesophagus: the real problem

The management of high-grade dysplasia within Barrett's oesophagus is highly topical and indeed controversial. It is becoming clear that radical surgery may be excessive treatment for many patients. This is because the natural history is not understood with some indicating of rapid degeneration to cancer, others demonstrating a low rate of degeneration over many years. Early detection and optical diagnosis has allowed minimally invasive destruction using endoscopic mucosal resection, thermal ablation and photodynamic therapy. Long-term eradication is possible and is real alternative to surgical excision. The current practice is variable and there is a requirement for randomised evidence comparing endoscopic therapy with surgical excision. This is becoming more appropriate with the development of minimally invasive oesophagectomy.