Background: The management of high-grade dysplasia (HGD) in Barrett's oesophagus is a controversial and challenging problem.
Methods: An up-to-date review of the literature has been made using Index Medicus, the Medline database, and cross-referencing of major articles on this subject.
Results: Diagnosis should be confirmed by a second expert pathologist. Repeat multiple jumbo biopsies and brushings need to be taken to reduce sample error and exclude associated invasive cancer. In young fit patients the advantages of surgery outweight the disadvantage of missing an early adenocarcinoma. Continued endoscopic surveillance may be more appropriate in elderly patients. New technology has increased the number of options. Early results of laser and multipolar electrocoagulation ablation of Barrett's epithelium are encouraging. Photodynamic therapy appears to be ideally suited to HGD and early cancers.
Conclusion: A selective approach to the management of HGD on an individual patient basis should be adopted.