Long-term nonsurgical management of Barrett's esophagus with high-grade dysplasia

Gastroenterology. 2001 Jun;120(7):1607-19. doi: 10.1053/gast.2001.25065.


Background & aims: Surgical resection of the esophagus is frequently recommended for Barrett's high-grade dysplasia (HGD) without cancer.

Methods: During a 20-year period, patients were diagnosed and observed through an organized surveillance program at the Hines Veterans Affairs Hospital. The program was supported by Hines VA and organized and managed by 2 endoscopists using preestablished endoscopic criteria.

Results: Barrett's esophagus was diagnosed in 1099 patients, and 36,251 esophageal mucosal specimens were reviewed. Seventy-nine of 1099 patients (7.2%) initially had HGD (34 prevalent) or subsequently developed HGD (45 incident) without evidence of cancer. Of the 75 HGD patients who remained without detectable cancer after the 1 year of intensive searching, 12 developed cancer (16%) during a mean 7.3-year surveillance period: 11 of the 12 who were compliant were considered cured with surgical or ablation therapy. Cancer did not develop in the remaining 63 HGD patients during the surveillance period.

Conclusions: HGD without cancer in Barrett's esophagus follows a relatively benign course in the majority of patients. In the patients who eventually progress to cancer during regular surveillance, surgical resection is curative. Surveillance endoscopies with biopsy is a valid and safe follow-up strategy for Barrett's patients who have HGD without cancer.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adenocarcinoma / etiology
  • Adult
  • Aged
  • Aged, 80 and over
  • Barrett Esophagus / complications
  • Barrett Esophagus / pathology
  • Barrett Esophagus / surgery*
  • Esophageal Neoplasms / etiology
  • Esophagectomy
  • Esophagus / pathology*
  • Female
  • Humans
  • Male
  • Middle Aged