Current Treatment Options in Gastroenterology

, Volume 4, Issue 1, pp 67–71 | Cite as

Dysplasia in Barrett’s esophagus

  • Marcos Pedrosa

Opinion statement

  • Dysplasia is the most important marker of progression to invasive cancer in Barrett’s esophagus.

  • Intensive endoscopic surveillance with biopsy may identify invasive cancer in a patient with high-grade dysplasia (HGD).

  • Close relationship with an experienced gastrointestinal pathologist and thoracic surgeon will improve treatment decisions and patient outcomes.

  • No intervention is required in patients with low-grade dysplasia (LGD); continued surveillance is recommended.

  • Surgical resection is the currently accepted therapy for high-grade dysplasia. Endoscopic ablative therapy remains experimental.


Proton Pump Inhibitor Photodynamic Therapy Intestinal Metaplasia Main Drug Interaction Porfimer Sodium 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Reid BJ, Levine DS, Longton G, et al.: Predictors of progression to cancer in Barrett’s esophagus: baseline histology and flow cytometry identify low- and highrisk patient subsets. Am J Gastroenterol 2000, 95:1669–1676.PubMedGoogle Scholar
  2. 2.
    Gimenez A, Minguela A, Parrilla P, et al.: Flow cytometric DNA analysis and p53 protein expression show a good correlation with histologic findings in patients with Barrett’s esophagus. Cancer 1998, 83:641–651.PubMedCrossRefGoogle Scholar
  3. 3.
    Cawley HM, Meltzer SJ, De Benedetti VM, et al.: Antip53 antibodies in patients with Barrett’s esophagus or esophageal carcinoma can predate cancer diagnosis. Gastroenterology 1998, 115:19–27.PubMedCrossRefGoogle Scholar
  4. 4.
    Levine DS: Management of dysplasia in the columnarlined esophagus. Gastro Clin N Am 1997, 26:613–634.CrossRefGoogle Scholar
  5. 5.
    Antonioli DA, Wang HH: Morphology of Barrett’s esophagus and Barrett’s associated dysplasia and adenocarcinoma. Gastro Clin N Am 1997, 26:495–506.CrossRefGoogle Scholar
  6. 6.
    Ibrahim NF: ACP best practice No. 155: guidelines for handling oesophageal biopsies and resection specimens and their reporting. J Clin Pathol 2000, 53:89–94.PubMedCrossRefGoogle Scholar
  7. 7.
    Reid BJ, Weinstein WM, Lewin KJ, et al.: Endoscopic biopsy can detect high-grade dysplasia or early carcinoma in Barrett’s esophagus without grossly recognized neoplastic lesion. Gastroenterolgy 1988, 94:81–90.Google Scholar
  8. 8.
    Reid BJ, Haggitt RC, Rubin CE: Observer variation in the diagnosis of dysplasia in Barrett’s esophagus. Hum Pathol 1988, 19:166–172.PubMedCrossRefGoogle Scholar
  9. 9.
    Alikhan M, Rex D, Khan A, et al.: Variable pathologic interpretation of columnar lined esophagus by general pathologists in community practice. Gastrointest Endosc 1999, 50:23–26.PubMedCrossRefGoogle Scholar
  10. 10.
    Pedrosa MC, Klein M, Sostek MB, et al.: Follow up of low-grade dysplasia in Barrett’s esophagus. Gastroenterology 1996, 110:A2633.Google Scholar
  11. 11.
    Cameron AJ: Management of Barrett’s esophagus. Mayo Clin Proc 1998, 73:457–461.PubMedCrossRefGoogle Scholar
  12. 12.
    Spechler SJ: Barrett’s esophagus: an overrated cancer risk factor. Gastroenterology 2000, 119:587–589.PubMedGoogle Scholar
  13. 13.
    Shaheen NJ, Crosbly MA, Bozymmski EM, et al.: Is there publication bias of cancer risk in Barrett’s esophagus. Gastroenterology 2000, 119:333–338.PubMedCrossRefGoogle Scholar
  14. 14.
    Rudolph RE, Vaughan TL, Storer BE, et al.: Effect of segment length on risk for neoplastic progression in patients with Barrett esophagus. Ann Intern Med 2000, 132:612–620.PubMedGoogle Scholar
  15. 15.
    Brand S, Wang TD, Schomaker KT, et al.: Detection of high grade dysplasia in Barrett’s esophagus by 5-aminolevulic acid protoporphyrin IX fluorescence spectroscopy. Gastroenterology 2000, 118:A1125.Google Scholar
  16. 16.
    Wallace MB, Perelman LT, Backman V, et al.: Endoscopic detection of dysplasia in patients with Barrett’s esophagus using light-scattering spectroscopy. Gastroenterology 2000, 119:677–682.PubMedCrossRefGoogle Scholar
  17. 17.
    Canto MI, Setrakian S, Willis J, et al.: Methylene blue-directed biopsies improve detection of intestinal metaplasia and dysplasia in Barrett’s esophagus. Gastrointest Endosc 2000, 51:560–568.PubMedCrossRefGoogle Scholar
  18. 18.
    Gangarosa LM, Halter S, Mertz H: Methylene blue staining and endoscopic ultrasound evaluation of Barrett’s esophagus with low-grade dysplasia. Dig Dis Sci 2000, 45:225–229.PubMedCrossRefGoogle Scholar
  19. 19.
    Triadafilopoulos G: Proton pump inhibitors for Barrett’s oesophagus. Gut 2000, 46:144–146.PubMedCrossRefGoogle Scholar
  20. 20.
    Provenzale D, Kemp JA, Arora S, et al.: A guide for surveillance of patients with Barrett’s esophagus. Am J Gastroenterol 1993, 89:670–680.Google Scholar
  21. 21.
    Schnell T, Sontag SJ, Chefjec et al.: High grade dysplasia is not an indication for surgery in patients with Barrett’s esophagus. Gastroenterology 1998, 114:A1149.Google Scholar
  22. 22.
    Levine DS, Haggitt RC, Blount PL, et al.: An endoscopic biopsy protocol can help differentiate high-grade dysplasia from early adenocarcinoma. Gastroenterology 1993, 105:40–50.PubMedGoogle Scholar
  23. 23.
    Falk GW, Catalano MF, Sivak MV, et al.: Endosonography in the evaluation of patients with Barrett’s esophagus and high-grade dysplasia. Gastrointest Endosc 1994, 40:207–212.PubMedCrossRefGoogle Scholar
  24. 24.
    Edwards MJ, Gable DR, Lentsch AB, Richardson JD: The rationale for esophagectomy as the optimal therapy for Barrett’s esophagus with high-grade dysplasia. Ann Surg 1996, 223:585–589.PubMedCrossRefGoogle Scholar
  25. 25.
    Zaninotto G, Parenti AR, Ruol A, et al.: Oesophageal resection for high-grade dysplasia in Barrett’s oesophagus. Br J Surg 2000, 87:1102–1105.PubMedCrossRefGoogle Scholar
  26. 26.
    Lightdale CJ: Ablation therapy for Barrett’s esophagus: is it time to choose our weapons? 1999, 49:122–125. Editorial from a leading investigator in the field.Google Scholar
  27. 27.
    Wolfsen HC: Photodynamic therapy in gastroenterology: current status in the year 2000. Endoscopy 2000, 32:715–719.PubMedCrossRefGoogle Scholar
  28. 28.
    Gossner L, Stolte M, Sroka R, et al.: Photodynamic ablation of high-grade dysplasia and early cancer in Barrett’s esophagus by means of 5-aminolevulinic acid. Gastroenterology 1998, 114:448–455. This article reports on a new photosensitizer for photodynamic therapy.PubMedCrossRefGoogle Scholar
  29. 29.
    Overholt BF, Panjehpour M, Haydek JM: Photodynamic therapy for Barrett’s esophagus: follow-up in 100 patients. Gastrointest Endosc 1999, 49:1–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Krishnadath KK, Wang KK, Taniguchi K, et al.: Persistent genetic abnormalities in Barrett’s esophagus after photodynamic therapy. Gastroenterology 2000, 119:624–630.PubMedCrossRefGoogle Scholar
  31. 31.
    Ell C, May A, Gossner L, et al.: Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett’s esophagus. Gastroenterology 2000, 118:670–677.PubMedCrossRefGoogle Scholar
  32. 32.
    Falk GW, Rice TW, Goldblum JR, Richter JE: Jumbo biopsy forceps protocol still misses unsuspected cancer in Barrett’sesophagus with high-grade dysplasia. Gastrointest Endosc 1999, 49:170–176.PubMedCrossRefGoogle Scholar
  33. 33.
    Van Laethem JL, Peny MO, Salmon I, et al.: Intramucosal adenocarcinoma under the squamous re-epithelialisation of Barrett’s esophagus. Gut 2000, 46:574–577. The first report of cancer underneath the regenerated squamous tissue.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2001

Authors and Affiliations

  • Marcos Pedrosa
    • 1
  1. 1.Division of GastroenterologyVeterans Affairs Boston Healthcare SystemBostonUSA

Personalised recommendations