High-grade dysplasia in Barrett's esophagus: The case for esophagectomy

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WHY MUST HIGH-GRADE DYSPLASIA BE RESECTED?

Arising in intestinal metaplasia of the esophagus, HGD is a malignant condition that is limited to the epithelium of the mucosal layer. Indeed, HGD, also termed carcinoma in situ, consists of unequivocal neoplastic abnormalities in the mucosal architecture and the cellular morphology of full thickness of the epithelium without any invasion of the lamina propria beyond the basement membrane. So, nuclei of the epithelial cells are enlarged, hyperchromatic, irregular, and polymitotic.35, 64 From a

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    • Personalizing Therapy for Esophageal Cancer Patients

      2013, Thoracic Surgery Clinics
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      High-grade dysplasia (HGD) has the highest risk of progression to adenocarcinoma, although the natural history of HGD remains unclear. Based on previous studies demonstrating that concomitant cancer was found in approximately 40% of surgically resected specimens of patients who had a preoperative diagnosis of only HGD,5,6 surgical resection of the esophagus (esophagectomy) has been recommended as standard of care. Esophagectomy is one of the most complex procedures used in the gastrointestinal tract, and its mortality rate may exceed 3%.7,8

    • American gastroenterological association technical review on the management of Barrett's esophagus

      2011, Gastroenterology
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      Endoscopists traditionally have used a 4-quadrant biopsy sampling system (which is essentially a random sampling technique) to find dysplasia in Barrett's esophagus, and it is clear that this system can miss areas of dysplasia and even cancer. In series of patients who underwent esophagectomies because endoscopic examination revealed high-grade dysplasia in Barrett's esophagus, for example, a number of studies have found that invasive cancer is present in 30% to 40% of the resected esophagi.87 However, a recent critical review of those studies suggests that 13% is a more accurate estimate of the frequency of invasive cancer in this situation, and when a careful endoscopic examination excludes all visible lesions, the frequency of finding invasive cancer at esophagectomy is only 3%.88

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      2010, Sleisenger and Fordtran’s Gastrointestinal and Liver Disease- 2 Volume Set: Pathophysiology, Diagnosis, Management, Expert Consult Premium Edition - Enhanced Online Features and Print
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