PRO: Esophagectomy is Indicated for High-Grade Dysplasia in Barrett's Esophagus

Whether treatment as radical as esophagectomy should be done for high-grade dysplasia of the esophagus (HGD) depends upon its risks and benefits compared to natural history and its results compared to alternate therapies. Treatment of HGD is controversial because its natural history is not fully understood. Contention is further heightened by review of the limited HGD literature that describes variable patient populations that include some patients who may not have HGD. In this state of incomplete knowledge, it is difficult, but not impossible, to determine the treatment of choice for HGD by considering its definition, detection, diagnosis, disputed natural history, and results of esophagectomy.

[1]  Bergein F Overholt,et al.  Photodynamic therapy with porfimer sodium for ablation of high-grade dysplasia in Barrett's esophagus: international, partially blinded, randomized phase III trial. , 2005, Gastrointestinal endoscopy.

[2]  S. Spechler,et al.  Dysplasia in Barrett's Esophagus: Limitations of Current Management Strategies , 2005, The American Journal of Gastroenterology.

[3]  J. Goldblum,et al.  Refining esophageal cancer staging. , 2003, The Journal of thoracic and cardiovascular surgery.

[4]  W H Henricks,et al.  Observer variation in the diagnosis of superficial oesophageal adenocarcinoma , 2002, Gut.

[5]  P. Pairolero,et al.  High-grade esophageal dysplasia: long-term survival and quality of life after esophagectomy. , 2002, The Annals of thoracic surgery.

[6]  J. Goldblum,et al.  Superficial adenocarcinoma of the esophagus. , 2001, The Journal of thoracic and cardiovascular surgery.

[7]  Dennis M. Riehle,et al.  Extent of high-grade dysplasia in Barrett's esophagus correlates with risk of adenocarcinoma. , 2001, Gastroenterology.

[8]  A. Sonnenberg,et al.  Long-term nonsurgical management of Barrett's esophagus with high-grade dysplasia. , 2001, Gastroenterology.

[9]  Patricia L. Blount,et al.  Optimizing endoscopic biopsy detection of early cancers in Barrett's high-grade dysplasia , 2000, American Journal of Gastroenterology.

[10]  J. Donovan,et al.  A prospective longitudinal study examining the quality of life of patients with esophageal carcinoma , 2000, Cancer.

[11]  J. Goldblum,et al.  Esophageal carcinoma: depth of tumor invasion is predictive of regional lymph node status. , 1998, The Annals of thoracic surgery.

[12]  R. Sampliner,et al.  Updated guidelines for the diagnosis, surveillance, and therapy of Barrett's esophagus , 2002, American Journal of Gastroenterology.