[Surgical management of early cancer in Barrett's esophagus]

The indication of surgical resection for early cancer in Barrett's esophagus is based on the risk of lymph node extension, which is conditioned by the depth of the lesions. Even if the high resolution endosonography is more sensitive than conventional endosonography for differentiating mucosal from submucosal lesions, it may be lacking for intermediate lesions (m3 and sm1). Macroscopic criteria are useful for identifying high-risk lesions. In contentious cases, endoscopic resection may be considered as a biopsy to determine the further treatment. The endoscopic resection is indicated for mucosal lesions in selected patients. Surgery remains the standard treatment for early cancer in Barrett's esophagus. The transhiatal resection is indicated for high-risk T1a mucosal lesions. The transthoracic resection is indicated for submucosal lesions.