Identification of high-grade dysplasia in Barrett's esophagus has been considered an indication for esophagectomy.
This is because of the high risk for coexisting cancer.
However, rigorous endoscopic surveillance programs recently have been recommended.
The programs recommend that esophagectomy be reserved for patients whose cancer is identified on biopsy.
This approach risks continued surveillance for patients who already have cancer unless reliable markers for the presence of occult cancer are identified.
Dr Tharavej and colleagues from California determined the endoscopic, histologic, and demographic features associated with occult cancer and high-grade dysplasia.
Endoscopic, histologic, and demographic findings for 31 patients who underwent esophagectomy for high-grade dysplasia were reviewed.
|Prevalence of coexisting cancer in patients with high-grade dysplasia was 45%|
The research team noted that the presence of an ulcer, nodule, stricture, or raised area on preoperative endoscopy.
The results of endoscopic biopsies taken before resection every 1 to 2 cm along the Barrett's segment were reviewed.
The high-grade dysplasia was categorized as unilevel if the dysplasia was limited to one level of biopsy and as multilevel if more than one level was involved.
The team divided patients into 2 groups according to the presence or absence of cancer in the resected specimens, and these variables were compared.
The researchers found that the prevalence of coexisting cancer in patients with high-grade dysplasia was 45%.
Of the 31 patients in this study, 9 had a visible lesion.
The team found cancer in the resected specimens from 7 of 9 patients with a visible lesion and 7 of 22 patients without a visible lesion.
Of 22 patients without a visible lesion, 10 had multilevel and 12 had unilevel high-grade dysplasia.
The team showed that 6 of 10 patients with multilevel high-grade dysplasia.
The research team observed that 1 of 12 patients with unilevel high-grade dysplasia had cancer in the resected esophagus.
Dr Tharavej's team concluded, “For patients with high-grade dysplasia, a lesion visible on endoscopy and/or high-grade dysplasia at multiple biopsy levels is associated with an increased risk for coexisting cancer.”
“These patients should be considered for early esophagectomy.”