Document Detail

Barrett's esophagus: management of high-grade dysplasia and cancer.
MedLine Citation:
PMID:  15013713     Owner:  NLM     Status:  MEDLINE    
Esophagectomy remains the treatment of choice for the appropriate patient with Barrett's adenocarcinoma invading beyond the mucosa, without evidence of distant metastasis or invasion of adjacent organs. On the other hand, therapeutic management of patients with Barrett's high-grade dysplasia (HGD) or mucosal adenocarcinoma should be individualized, taking into account the patient's preferences, willingness to return for frequent endoscopic biopsies, and medical fitness to undergo esophagectomy. Surgery has to be considered the best treatment for HGD or superficial carcinoma, unless contraindicated by severe comorbidities, because it has proven to be the only treatment that is successful in curing the condition and preventing recurrent HGD or the development of invasive cancer. Nonsurgical treatment by photodynamic therapy or endoscopic mucosal resection may be a less invasive and organ-sparing option for elderly, poor-risk patients but it is still to be considered an investigational therapy that should only be conducted under a clinical trial protocol. Finally, intensive endoscopic biopsy surveillance of patients with HGD is another investigational option that may allow prompt treatment of cancer if it develops. However, few data document the safety of this observational approach.
Alberto Ruol; Giovanni Zaninotto; Mario Costantini; Giorgio Battaglia; Matteo Cagol; Rita Alfieri; Magdalena Epifani; Ermanno Ancona
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  The Journal of surgical research     Volume:  117     ISSN:  0022-4804     ISO Abbreviation:  J. Surg. Res.     Publication Date:  2004 Mar 
Date Detail:
Created Date:  2004-03-11     Completed Date:  2004-05-25     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0376340     Medline TA:  J Surg Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  44-51     Citation Subset:  IM    
Clinica Chirurgica 3 degrees, University of Padova, Padova, Italy.
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MeSH Terms
Adenocarcinoma / pathology,  therapy*
Barrett Esophagus / pathology*,  physiopathology,  therapy*
Biopsy / methods
Cell Transformation, Neoplastic / pathology
Combined Modality Therapy
Electrocoagulation / methods
Esophageal Neoplasms / pathology,  therapy*
Esophagectomy / methods
Esophagus / pathology*,  surgery
Laser Therapy / methods
Photochemotherapy / methods

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