Management of Barrett's esophagus with dysplasia

Barrett's esophagus is a metaplastic change in the mucosal lining which represents a peculiar form of healing in response to the chronic injury due to gastroesophageal reflux. It has been recognized that this change is associated with an increased risk of developing esophageal adenocarcinoma. Several factors have been shown to identify the patients who are at particular risk for carcinoma, the most importance of which is the development of dysplasia. As a result, management of patients with Barrett's esophagus must include careful endoscopic surveillance with histological examination of the biopsies by two independent experienced pathologists. Patients with low-grade dysplasia require complete control of reflux and careful endoscopic surveillance. Because the majority of patients with high-grade dysplasia will have co-existent adenocarcinoma, and because of difficulties in differentiating high-grade dysplasia from invasive adenocarcinoma, esophagectomy is the treatment of choice for these individuals. This approach has been shown to result in a significant improvement in survival in patients with esophageal cancer identified under surveillance.