Book chapter
Management of Dysplastic Barrett’s Esophagus
The AFS Textbook of Foregut Disease, pp 179-188
2023
Abstract
The presence and degree of dysplasia is the best marker to predict progression of Barrett’s esophagus (BE) to esophageal adenocarcinoma (EAC). Patients with BE should undergo thorough and comprehensive endoscopy with chromoendoscopy to identify regions that may be at higher risk for dysplasia. Any regions of BE with nodularity and areas of mucosal irregularity must be first considered for endoscopic resection as this provides most accurate staging and is potentially curative for early-stage EAC. Following initial endoscopic resections, endoscopic eradication therapy (EET) is usually accomplished with ablative modalities. Of these, RFA has been best studied and is considered the standard. Newer modalities such as cryoablation appear promising, particularly in patients with disease refractory to RFA. Hybrid APC may offer a cost-effective option for patients with smaller areas of residual disease. Despite its positive outcomes for palliation of obstructive EAC, the role of PDT in the management of the dysplastic BE is most limited by subpar efficacy, prolonged light avoidance, and high cost. Across all modalities, length of the initial BE segment is a major influencer in response to treatment. Following EET, aggressive medical or surgical control of GERD is paramount for preventing recurrence.
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Details
- Title
- Management of Dysplastic Barrett’s Esophagus
- Creators
- Andrew D. Grubic - Allegheny Health NetworkShahin Ayazi - Allegheny Health NetworkManish K. Dhawan - Allegheny Health NetworkBlair A. Jobe - Drexel University
- Contributors
- Ninh T. Nguyen (Editor)John O. Clarke (Editor)John C. Lipham (Editor)Kenneth J. Chang (Editor)Felice Schnoll-Sussman (Editor)Reginald C.W. Bell (Editor)Peter J. Kahrilas (Editor)
- Publication Details
- The AFS Textbook of Foregut Disease, pp 179-188
- Publisher
- Springer International Publishing; Cham
- Number of pages
- 10
- Resource Type
- Book chapter
- Language
- English
- Academic Unit
- Surgery
- Scopus ID
- 2-s2.0-85200431961
- Other Identifier
- 991022048291004721