Current Management of Low-Grade Dysplasia in Barrett Esophagus

Low-grade dysplasia in Barrett esophagus remains an ongoing challenge in clinical management. Recent studies suggest an increased risk in progression of low-grade dysplasia to high-grade dysplasia and/or adenocarcinoma. This is especially seen when 1 or more expert gastrointestinal pathologist confirms the diagnosis and in the setting of low-grade dysplasia that persists on more than 1 endoscopy. In the setting of confirmed and persistent low-grade dysplasia, level 1 evidence supports endoscopic ablation as a treatment option for these patients, although continued surveillance remains a viable option. Current management of these patients emphasizes the importance of the following principles: (1) biopsies should not be obtained in the setting of erosive esophagitis; (2) any diagnosis of low-grade dysplasia should be confirmed by a second pathologist with extensive expertise in Barrett esophagus; (3) surveillance endoscopy should be repeated within 3 to 6 months of the initial diagnosis with rigorous visual inspection to exclude higher-level lesions; and (4) the advantages and disadvantages of both endoscopic ablation and continued surveillance should be reviewed with the patient.