Mucosectomy for high-grade dysplasia in Barrett's esophagus

Massimo Picasso, Sabrina Blanchi, Rosangela Filiberti, Marcello Di Muzio, Massimo Conio

Research output: Contribution to journalArticle

Abstract

Reports on the natural history of high-grade dysplasia (HGD) are sometimes contradictory, but suggest that 10-30% of patients with HGD in Barrett's esophagus (BE) will develop a demonstrable malignancy within five years of the initial diagnosis. Surgery has to be considered the best treatment for HGD or superficial carcinoma, but is contraindicated in patients with severe comorbidities. Non-surgical treatments such as intensive endoscopic surveillance, endoscopic ablative therapies, and endoscopic mucosal resection (EMR) have been proposed. EMR is a newly developed procedure promising to become a safe and reliable non-operative option for the endoscopic removal of HGD or early cancer within BE. It is important to assess the depth of invasion of the lesion and lymph node involvement before choosing EMR. This technique permits more effective staging of disease obtaining a large sample leading to a precise assessment of the depth of malignant invasion. Complications such as bleeding and perforation may occur, but can be treated endoscopically. Trials are needed to compare endoscopic therapy with surgical resection to establish clear criteria for EMR and ablative therapies.

Original languageEnglish
Pages (from-to)325-330
Number of pages6
JournalMinimally Invasive Therapy and Allied Technologies
Volume15
Issue number6
DOIs
Publication statusPublished - Dec 2006

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Keywords

  • Barrett's esophagus
  • Endoscopic mucosal resection
  • High-grade dysplasia

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Surgery

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