Endoscopic treatment of high-grade dysplasia and early cancer in Barrett's oesophagus

Massimo Conio, Alan J. Cameron, Amitabh Chak, Sabrina Blanchi, Rosangela Filiberti

Research output: Contribution to journalArticle

Abstract

Barrett's oesophagus is the premalignant precursor of oesophageal adenocarcinoma. Non-dysplastic metaplasia can progress to low-grade dysplasia, high-grade dysplasia, and finally to invasive cancer. Although the frequency of adenocarcinoma in patients with Barrett's oesophagus is low, surveillance is justified because the outcome of adenocarcinoma is poor. Oesophagectomy remains the standard treatment for patients with high-grade dysplasia and superficial carcinoma. However, it has been associated with substantial morbidity and mortality and some patients are judged unfit for surgery. In this review, the present status of less invasive procedures is discussed. Endotherapy preserves the integrity of the oesophagus and allows a better quality of life to patients at low risk of developing lymph-node metastases. Opposition to endoscopic treatment is based mainly on the identification of undetected foci of cancer and high-grade dysplasia in oesophagectomy samples. The current ablative techniques used are photodynamic therapy, argon plasma coagulation, laser treatment, and endoscopic mucosal resection.

Original languageEnglish
Pages (from-to)311-321
Number of pages11
JournalThe Lancet Oncology
Volume6
Issue number5
DOIs
Publication statusPublished - May 2005

ASJC Scopus subject areas

  • Oncology

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