High-grade dysplasia and intramucosal adenocarcinoma in Barrett's esophagus: the role of esophagectomy in the era of endoscopic eradication therapy.

Overview

PURPOSE OF REVIEW: The aim of this review is to evaluate the role of esophagectomy for high-grade dysplasia (HGD) and intramucosal adenocarcinoma (IMC) in light of recent advances in endoscopic therapy for Barrett's esophagus. RECENT FINDINGS: Radiofrequency ablation (RFA) and endoscopic mucosal resection (EMR) are proven well tolerated and effective, at least in midterm follow-up. The application of these techniques has opened a new road for the local treatment of esophageal HGD and IMC. To safely employ these techniques, reliable and accurate staging of the esophageal neoplasm is essential. EMR has taken a central role, as it allows the pathologist to provide tumor-staging information necessary for an appropriate clinical management decision process. Unfortunately, both RFA and EMR have limitations that preclude their universal use in the treatment of early esophageal cancer. In some cases, esophagectomy still remains the best treatment option. The evolution of the minimally invasive approach to esophagectomy may improve outcomes of this major operation. SUMMARY: A better understanding of the indications and limitations of endoscopic therapy for HGD and IMC permits a tailored approach to the management of patients with early esophageal adenocarcinoma. When indicated, the selection of a less morbid surgical technique has the potential to improve overall surgical and oncological outcomes.