From the Guidelines
The treatment of choice for Barrett’s esophagus with severe dysplasia is endoscopic resection of visible oesophageal lesions as first-line treatment, followed by endoscopic ablation of any residual Barrett’s oesophagus. According to the national institute for health and care excellence (NICE) guidance on monitoring and management of Barrett's oesophagus and stage I oesophageal adenocarcinoma 1, this approach is recommended for people with high-grade dysplasia. Severe dysplasia in Barrett's esophagus represents a significant risk for progression to adenocarcinoma, and endoscopic resection and ablation have been shown to be effective in reducing this risk.
The key points to consider in the management of Barrett’s esophagus with severe dysplasia are:
- Endoscopic resection of visible oesophageal lesions as first-line treatment 1
- Endoscopic ablation of any residual Barrett’s oesophagus after treatment with endoscopic resection 1
- The importance of confirming the histological diagnosis by two gastrointestinal pathologists 1
- The role of endoscopic surveillance and dose optimisation of acid-suppressant medication in certain cases 1
In contrast, options such as esophagectomy, Nissen fundoplication, and proton pump inhibitors may not be the most appropriate choices for the treatment of Barrett’s esophagus with severe dysplasia. Esophagectomy is a more invasive procedure that may be considered in certain cases, but it is not the first-line treatment recommended by NICE guidance 1. Nissen fundoplication and proton pump inhibitors may be used in the management of gastroesophageal reflux disease, but they do not address the high cancer risk associated with severe dysplasia in Barrett's esophagus.
From the Research
Treatment Options for Barrett's Esophagus with Severe Dysplasia
- The treatment of choice for Barrett's esophagus with severe dysplasia is a topic of discussion among medical professionals, with various options available, including:
- Esophagectomy: a surgical procedure to remove the esophagus, which is considered the most effective treatment for eradicating the neoplastic epithelium 2, 3
- Endoscopic ablative therapies: such as endoscopic mucosal resection (EMR) and radiofrequency ablation (RFA), which can be used to remove the affected tissue and prevent progression to cancer 4, 5
- Endoscopic surveillance: regular monitoring of the esophagus to detect any changes or progression to cancer, which may be suitable for patients who are not candidates for surgery or ablative therapies 4, 6
- Esophagectomy is considered the treatment of choice for patients with Barrett's esophagus and high-grade dysplasia who are healthy and have a reasonable life expectancy 3
- However, esophagectomy is a major surgical procedure with significant morbidity and mortality, and alternative treatments such as endoscopic ablative therapies and surveillance may be considered for patients who are not candidates for surgery or have a high risk of complications 2, 6, 5
Considerations for Treatment
- The natural history of Barrett's esophagus with high-grade dysplasia is not well understood, and the risk of progression to cancer is significant 4
- The choice of treatment depends on various factors, including the patient's overall health, the extent of the disease, and the presence of any comorbidities 3, 6
- A multidisciplinary approach, involving gastroenterologists, surgeons, and other healthcare professionals, is essential for determining the best course of treatment for each patient 2, 5