Skip to main content
SpringerLink
Log in

Endoscopic Treatment of High-Grade Dysplasia and Early Esophageal Cancer

  • Surgical Symposium Contribution
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

The emergence of novel endoscopic modalities has challenged the role of surgery for patients with Barrett’s esophagus (BE) and high-grade dysplasia (HGD) or early esophageal adenocarcinoma.

Aim

The aim of this study was to review the available evidence of the endoscopic treatment of HGD and early esopahgeal adenocarcinoma.

Results

For most patients with BE and HGD, endoscopic ablative therapy is the preferred treatment strategy. Patients with intramucosal adenocarcinoma (T1a) should be treated with endoscopic mucosal resection (EMR) followed by ablative therapy, in order to eradicate the remaining intestinal metaplasia. The best approach to treatment of adenocarcinoma with submucosal invasion (T1b) remains elusive. Endoscopic resection may be suitable for low-risk T1b tumors (well differentiated, without lymphovascular invasion and with superficial submucosal invasion); however, further data are necessary to better risk stratify this group. Careful endoscopic surveillance is recommended following complete eradication of intestinal metaplasia to detect recurrent disease.

Conclusion

Patients with BE and HGD should undergo endoscopic ablative therapy. Patients with T1a adenocarcinoma should be treated with EMR and subsequent ablation of the entire BE segment. Low-risk T1b tumors may be suitable for endoscopic resection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Shaheen NJ, Falk GW, Iyer PG, Gerson LB (2016) ACG clinical guideline: diagnosis and management of Barrett’s esophagus. Am J Gastroenterol 111:30–50

    Article  CAS  PubMed  Google Scholar 

  2. Rastogi A, Puli S, El-Serag HB et al (2008) Incidence of esophageal adenocarcinoma in patients with Barrett’s esophagus and high-grade dysplasia: a meta-analysis. Gastrointest Endosc 67:394–398

    Article  PubMed  Google Scholar 

  3. Heitmiller RF (2003) Prophylactic esophagectomy in Barrett esophagus with high-grade dysplasia. Langenbecks Arch Surg 388(2):83–87

    PubMed  Google Scholar 

  4. Tseng EE, Wu TT, Yeo CJ, Heitmiller RF (2003) Barrett’s esophagus with high grade dysplasia: surgical results and long-term outcome–an update. J Gastrointest Surg 7(2):164–170

    Article  PubMed  Google Scholar 

  5. Reed MF, Tolis G Jr, Edil BH, Allan JS, Donahue DM, Gaissert HA, Moncure AC, Wain JC, Wright CD, Mathisen DJ (2005) Surgical treatment of esophageal high-grade dysplasia. Ann Thorac Surg 79(4):1110–1115

    Article  PubMed  Google Scholar 

  6. Dunbar KB, Spechler SJ (2012) The risk of lymph-node metastases in patients with high-grade dysplasia or intramucosal carcinoma in Barrett’s esophagus: a systematic review. Am J Gastroenterol 107(6):850–862

    Article  PubMed  PubMed Central  Google Scholar 

  7. Markar SR, Karthikesalingam A, Thrumurthy S, Low DE (2012) Volume-outcome relationship in surgery for esophageal malignancy: systematic review and meta-analysis 2000–2011. J Gastrointest Surg 16(5):1055–1063

    Article  PubMed  Google Scholar 

  8. Raymond DP, Seder CW, Wright CD, Magee MJ, Kosinski AS, Cassivi SD, Grogan EL, Blackmon SH, Allen MS, Park BJ, Burfeind WR, Chang AC, DeCamp MM, Wormuth DW, Fernandez FG, Kozower BD (2016) Predictors of major morbidity or mortality after resection for esophageal cancer: a society of thoracic surgeons general thoracic surgery database risk adjustment model. Ann Thorac Surg 102(1):207–214

    Article  PubMed  Google Scholar 

  9. Ell C, May A, Pech O, Gossner L, Guenter E, Behrens A, Nachbar L, Huijsmans J, Vieth M, Stolte M (2007) Curative endoscopic resection of early esophageal adenocarcinomas (Barrett’s cancer). Gastrointest Endosc 65(1):3–10

    Article  PubMed  Google Scholar 

  10. Sharma P, Morales TG, Sampliner RE (1998) Short segment Barrett’s esophagus–the need for standardization of the definition and of endoscopic criteria. Am J Gastroenterol 93(7):1033–1036

    CAS  PubMed  Google Scholar 

  11. Sharma P, Dent J, Armstrong D, Bergman JJ, Gossner L, Hoshihara Y, Jankowski JA, Junghard O, Lundell L, Tytgat GN, Vieth M (2006) The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology 131(5):1392–1399

    Article  PubMed  Google Scholar 

  12. Qumseya BJ, Wang H, Badie N, Uzomba RN, Parasa S, White DL, Wolfsen H, Sharma P, Wallace MB (2013) Advanced imaging technologies increase detection of dysplasia and neoplasia in patients with Barrett’s esophagus: a meta-analysis and systematic review. Clin Gastroenterol Hepatol 11(12):1562–1570

    Article  PubMed  PubMed Central  Google Scholar 

  13. Canto MI, Anandasabapathy S, Brugge W, Falk GW, Dunbar KB, Zhang Z, Woods K, Almario JA, Schell U, Goldblum J, Maitra A, Montgomery E, Kiesslich R (2014) Confocal endomicroscopy for Barrett’s esophagus or Confocal Endomicroscopy for Barrett’s Esophagus (CEBE) Trial Group. In vivo endomicroscopy improves detection of Barrett’s esophagus-related neoplasia: a multicenter international randomized controlled trial (with video). Gastrointest Endosc 79(2):211–221

    Article  PubMed  Google Scholar 

  14. Alikhan M, Rex D, Khan A, Rahmani E, Cummings O, Ulbright TM (1999) Variable pathologic interpretation of columnar lined esophagus by general pathologists in community practice. Gastrointest Endosc 50:23–26

    Article  CAS  PubMed  Google Scholar 

  15. Edge SB, Byrd DR, Compton CC et al (2010) AJCC cancer, staging manual, 7th edn. Springer, New York

    Google Scholar 

  16. Marsman WA, Brink MA, Bergman JJ, Tytgat GN, ten Kate FJ, van Lanschot JJ, Fockens P (2006) Potential impact of EUS-FNA staging of proximal lymph nodes in patients with distal esophageal carcinoma. Endoscopy 38:825–829

    Article  CAS  PubMed  Google Scholar 

  17. Pouw RE, Heldoorn N, Alvarez Herrero L, ten Kate FJ, Visser M, Busch OR, van Berge Henegouwen MI, Krishnadath KK, Weusten BL, Fockens P, Bergman JJ (2011) Do we still need EUS in the workup of patients with early esophageal neoplasia? A retrospective analysis of 131 cases. Gastrointest Endosc 73(4):662–668

    Article  PubMed  Google Scholar 

  18. Overholt BF, Lightdale CJ, Wang KK, Canto MI, Burdick S, Haggitt RC, Bronner MP, Taylor SL, Grace MG, Depot M (2005) International photodynamic group for high-grade dysplasia in Barrett’s esophagus. Photodynamic therapy with porfimer sodium for ablation of high-grade dysplasia in Barrett’s esophagus: international, partially blinded, randomized phase III trial. Gastrointest Endosc 62(4):488–498

    Article  PubMed  Google Scholar 

  19. Prasad GA, Wang KK, Buttar NS, Wongkeesong LM, Krishnadath KK, Nichols FC 3rd, Lutzke LS, Borkenhagen LS (2007) Long-term survival following endoscopic and surgical treatment of high-grade dysplasia in Barrett’s esophagus. Gastroenterology 132(4):1226–1233

    Article  PubMed  PubMed Central  Google Scholar 

  20. Shaheen NJ, Sharma P, Overholt BF, Wolfsen HC, Sampliner RE, Wang KK, Galanko JA, Bronner MP, Goldblum JR, Bennett AE, Jobe BA, Eisen GM, Fennerty MB, Hunter JG, Fleischer DE, Sharma VK, Hawes RH, Hoffman BJ, Rothstein RI, Gordon SR, Mashimo H, Chang KJ, Muthusamy VR, Edmundowicz SA, Spechler SJ, Siddiqui AA, Souza RF, Infantolino A, Falk GW, Kimmey MB, Madanick RD, Chak A, Lightdale CJ (2009) Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med 360(22):2277–2288

    Article  CAS  PubMed  Google Scholar 

  21. Shaheen NJ, Overholt BF, Sampliner RE, Wolfsen HC, Wang KK, Fleischer DE, Sharma VK, Eisen GM, Fennerty MB, Hunter JG, Bronner MP, Goldblum JR, Bennett AE, Mashimo H, Rothstein RI, Gordon SR, Edmundowicz SA, Madanick RD, Peery AF, Muthusamy VR, Chang KJ, Kimmey MB, Spechler SJ, Siddiqui AA, Souza RF, Infantolino A, Dumot JA, Falk GW, Galanko JA, Jobe BA, Hawes RH, Hoffman BJ, Sharma P, Chak A, Lightdale CJ (2011) Durability of radiofrequency ablation in Barrett’s esophagus with dysplasia. Gastroenterology 141(2):460–468

    Article  PubMed  PubMed Central  Google Scholar 

  22. Shaheen NJ, Greenwald BD, Peery AF, Dumot JA, Nishioka NS, Wolfsen HC, Burdick JS, Abrams JA, Wang KK, Mallat D, Johnston MH, Zfass AM, Smith JO, Barthel JS, Lightdale CJ (2010) Safety and efficacy of endoscopic spray cryotherapy for Barrett’s esophagus with high-grade dysplasia. Gastrointest Endosc 71(4):680–685

    Article  PubMed  PubMed Central  Google Scholar 

  23. Gosain S, Mercer K, Twaddell WS, Uradomo L, Greenwald BD (2013) Liquid nitrogen spray cryotherapy in Barrett’s esophagus with high-grade dysplasia: long-term results. Gastrointest Endosc 78(2):260–265

    Article  PubMed  Google Scholar 

  24. Friedland S, Triadafilopoulos G (2011) A novel device for ablation of abnormal esophageal mucosa (with video). Gastrointest Endosc 74(1):182–188

    Article  PubMed  Google Scholar 

  25. Canto MI, Shin EJ, Khashab MA et al. (2016) Multifocal nitrous oxide cryoballoon ablation with or without Endoscopic mucosal resection (EMR) for treatment of neoplastic Barrett’s Esophagus (BE): preliminary results of a prospective clinical trial in treatment-naive and previously ablated patients. Digestive Disease Week (DDW) presentation 638

  26. Cabau M, Luc G, Terrebonne E, Belleanne G, Vendrely V, Sa Cunha A, Collet D (2013) Lymph node invasion might have more prognostic impact than R status in advanced esophageal adenocarcinoma. Am J Surg 205(6):711–717

    Article  PubMed  Google Scholar 

  27. Bhamidipati CM, Stukenborg GJ, Thomas CJ, Lau CL, Kozower BD, Jones DR (2012) Pathologic lymph node ratio is a predictor of survival in esophageal cancer. Ann Thorac Surg 94(5):1643–1651

    Article  PubMed  Google Scholar 

  28. Pennathur A, Farkas A, Krasinskas AM, Ferson PF, Gooding WE, Gibson MK, Schuchert MJ, Landreneau RJ, Luketich JD (2009) Esophagectomy for T1 esophageal cancer: outcomes in 100 patients and implications for endoscopic therapy. Ann Thorac Surg 87:1048–1054

    Article  PubMed  PubMed Central  Google Scholar 

  29. Sepesi B, Watson TJ, Zhou D, Polomsky M, Litle VR, Jones CE, Raymond DP, Hu R, Qiu X, Peters JH (2010) Are endoscopic therapies appropriate for superficial submucosal esophageal adenocarcinoma? An analysis of esophagectomy specimens. J Am Coll Surg 210:418–427

    Article  PubMed  Google Scholar 

  30. Hagen JA, DeMeester TR (2001) Esophageal adenocarcinoma. Ann Thorac Surg 72:1430–1432

    Article  CAS  PubMed  Google Scholar 

  31. Pech O, May A, Manner H, Behrens A, Pohl J, Weferling M, Hartmann U, Manner N, Huijsmans J, Gossner L, Rabenstein T, Vieth M, Stolte M, Ell C (2014) Long-term efficacy and safety of endoscopic resection for patients with mucosal adenocarcinoma of the esophagus. Gastroenterology 146(3):652–660

    Article  PubMed  Google Scholar 

  32. Leers JM, DeMeester SR, Oezcelik A, Klipfel N, Ayazi S, Abate E, Zehetner J, Lipham JC, Chan L, Hagen JA, DeMeester TR (2011) The prevalence of lymph node metastases in patients with T1 esophageal adenocarcinoma a retrospective review of esophagectomy specimens. Ann Surg 253(2):271–278

    Article  PubMed  Google Scholar 

  33. Pech O, Behrens A, May A, Nachbar L, Gossner L, Rabenstein T, Manner H, Guenter E, Huijsmans J, Vieth M, Stolte M, Ell C (2008) Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett’s oesophagus. Gut 57(9):1200–1206

    Article  CAS  PubMed  Google Scholar 

  34. Cen P, Hofstetter WL, Correa AM, Wu TT, Lee JH, Ross WA, Davilla M, Swisher SG, Fukami N, Rashid A, Maru D, Ajani JA (2008) Lymphovascular invasion as a tool to further subclassify T1b esophageal adenocarcinoma. Cancer 112(5):1020–1027

    Article  PubMed  Google Scholar 

  35. Ancona E, Rampado S, Cassaro M, Battaglia G, Ruol A, Castoro C, Portale G, Cavallin F, Rugge M (2008) Prediction of lymph node status in superficial esophageal carcinoma. Ann Surg Oncol 15(11):3278–3288

    Article  PubMed  Google Scholar 

  36. Boys JA, Worrell SG, Chandrasoma P, Vallone JG, Maru DM, Zhang L, Blackmon SH, Dickinson KJ, Dunst CM, Hofstetter WL, Lada MJ, Louie BE, Molena D, Watson TJ, DeMeester SR (2016) Can the risk of lymph node metastases be gauged in endoscopically resected submucosal esophageal adenocarcinomas? A multi-center study. J Gastrointest Surg 20:6–12

    Article  PubMed  Google Scholar 

  37. Manner H, Pech O, Heldmann Y, May A, Pohl J, Behrens A, Gossner L, Stolte M, Vieth M, Ell C (2013) Efficacy, safety, and longterm results of endoscopic treatment for early stage adenocarcinoma of the esophagus with low-risk sm1 invasion. Clin Gastroenterol Hepatol 11(6):630–635

    Article  PubMed  Google Scholar 

  38. Molena D, Schlottmann F, Boys JA, Blackmon SH, Dickinson KJ, Dunst CM, Hofstetter WL, Lada MJ, Louie BE, Mungo B, Watson TJ, DeMeester SR (2016) Esophagectomy following endoscopic resection of submucosal esophageal cancer: a highly curative procedure even with nodal metastases. J Gastrointest Surg 21(1):62–67

    Article  PubMed  Google Scholar 

  39. Pasricha S, Bulsiewicz WJ, Hathorn KE, Komanduri S, Muthusamy VR, Rothstein RI, Wolfsen HC, Lightdale CJ, Overholt BF, Camara DS, Dellon ES, Lyday WD, Ertan A, Chmielewski GW, Shaheen NJ (2014) Durability and predictors of successful radiofrequency ablation for Barrett’s esophagus. Clin Gastroenterol Hepatol 12(11):1840–1847

    Article  PubMed  PubMed Central  Google Scholar 

  40. Phoa KN, Pouw RE, van Vilsteren FG, Sondermeijer CM, Ten Kate FJ, Visser M, Meijer SL, van Berge Henegouwen MI, Weusten BL, Schoon EJ, Mallant-Hent RC, Bergman JJ (2013) Remission of Barrett’s esophagus with early neoplasia 5 years after radiofrequency ablation with endoscopic resection: a Netherlands cohort study. Gastroenterology 145(1):96–104

    Article  PubMed  Google Scholar 

  41. Gaddam S, Singh M, Balasubramanian G, Thota P, Gupta N, Wani S, Higbee AD, Mathur SC, Horwhat JD, Rastogi A, Young PE, Cash BD, Bansal A, Vargo JJ, Falk GW, Lieberman DA, Sampliner RE, Sharma P (2013) Persistence of nondysplastic Barrett’s esophagus identifies patients at lower risk for esophageal adenocarcinoma: results from a large multicenter cohort. Gastroenterology 145(3):548–553

    Article  PubMed  Google Scholar 

  42. Gray NA, Odze RD, Spechler SJ (2011) Buried metaplasia after endoscopic ablation of Barrett’s esophagus: a systematic review. Am J Gastroenterol 106(11):1899–1908

    Article  PubMed  PubMed Central  Google Scholar 

  43. Zhou C, Tsai TH, Lee HC, Kirtane T, Figueiredo M, Tao YK, Ahsen OO, Adler DC, Schmitt JM, Huang Q, Fujimoto JG, Mashimo H (2012) Characterization of buried glands before and after radiofrequency ablation by using 3-dimensional optical coherence tomography (with videos). Gastrointest Endosc 76(1):32–40

    Article  PubMed  PubMed Central  Google Scholar 

  44. Shafa S, Shaheen NJ (2016) Buried Barrett’s esophagus-a sheep in sheep’s clothing. J Gastrointest Surg 20:1281–1283

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery and Center for Esophageal Diseases and Swallowing, University of North Carolina, Chapel Hill, NC, USA

    Francisco Schlottmann & Marco G. Patti

  2. Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, CB#7080, Chapel Hill, NC, 27599-7080, USA

    Marco G. Patti & Nicholas J. Shaheen

Authors
  1. Francisco Schlottmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marco G. Patti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicholas J. Shaheen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nicholas J. Shaheen.

Ethics declarations

Conflict of interest

The authors have no conflict of interest to declare.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schlottmann, F., Patti, M.G. & Shaheen, N.J. Endoscopic Treatment of High-Grade Dysplasia and Early Esophageal Cancer. World J Surg 41, 1705–1711 (2017). https://doi.org/10.1007/s00268-017-3977-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-017-3977-8

Keywords

Search

Navigation