Treatment of Barrett's Esophagus with Confirmed High-Grade Dysplasia or Intramucosal Carcinoma
When Barrett's esophagus progresses to pathologically confirmed high-grade dysplasia (HGD) or intramucosal carcinoma (IMC), the clinical situation demands active intervention. Surveillance alone is no longer appropriate — evidence strongly favours endoscopic management over surgical alternatives in this population.
Clinical Scenario
Barrett's esophagus with pathologically confirmed esophageal
high-grade dysplasia (HGD) or
intramucosal carcinoma (IMC) — a well-defined indication for eradication therapy.
Treatment Approach
The cornerstone of management is
endoscopic eradication therapy (EET) — an endoscopy-based strategy that combines an initial step directed at visible disease within the Barrett's segment with a subsequent ablative phase targeting the remaining epithelium. The complete procedural sequence, preferred ablative technique, and adjunctive regimen are detailed in the full protocol.
Clinical goals: Complete eradication of dysplasia (CED) and complete eradication of intestinal metaplasia (CEIM) of the esophagus — both targeted within 18 months.
References
DOI: 10.14309/ajg.0000000000001680
- We recommend EET compared with esophagectomy in patients with BE with HGD or IMC (strength of recommendation: strong; quality of evidence: moderate).
- We suggest initial ER of any visible lesions before the application of ablative therapy in patients with BE undergoing EET (strength of recommendation: conditional; quality of evidence: very low).
- Priority quality indicators established include monitoring the rate at which CEIM is achieved by 18 months in patients with BE-related dysplasia and IMC referred for EET (outcome measure, threshold 70%), and the rate at which CED is achieved by 18 months in patients with BE-related dysplasia and IMC referred for EET (outcome measure, threshold 80%).
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