Management

The progress of Barrett's to severe dysplasia marks it as a premalignant lesion and current thought is to treat is as such with early resection (Table 10.1).

No or Mild Dysplasia - endoscopy with biopsy at 1-2 year intervals.

Moderate Dysplasia - endoscopy with biopsy at 6 month intervals

Severe Dysplasia — synonymous with carcinoma in situ and is an indication for resection.

Patients with chronic reflux should be aggressively treated medically. If this fails they should then undergo a fundoplication. Even after surgical intervention for reflux, Barrett's does not usually regress and requires constant surveillance. This is an important point in that performing fundoplication for reflux utilizes the future conduit for esophageal reconstruction and must be considered prior to surgery.

In recent reports, invasive carcinoma has been found in up to 50% of patients undergoing resection for severe dysplasia.

Maximum Review

• Accounts for 2-8% of esophageal cancers

• Presentation with GERD, dysphasia

• Diagnose with EGD and biopsy with mucosal changes 2 cm above the GE junction

• Surveillance of Barrett's

• Severe dysplasia is consistent with carcinoma in situ

• Early surgery can result in high cure rates

References

1. Siewart JR, Stein HJ. Barrett's cancer: Indications, extent and result of surgical resection. Semin Surg Oncol 1997; 13:245-252.

2. Cameron JL. Current Surgical Therapy. 6th ed. St Louis: Mosby 1998.

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