Curbside Consultation in GERD: 49 Clinical Questions

Philip O. Katz, MD

Question 31: What Are The Management Options For Dysplasia In Patients With Barrett’S Esophagus, Specifically High-Grade Dysplasia? (continued)

A dilemma for the clinician is how to manage a patient in whom high-grade dysplasia (HGD) is detected on biopsy. The first step in management is to confirm the diagnosis by review by an expert pathologist, as separating HGD from cancer can be difficult (Figure 31-1). Dysplasia should be classified as focal or diffuse. The controversy then revolves around the following. Should an immediate esophagectomy be performed, should the patient undergo intensive surveillance with esophagectomy performed only if cancer is discovered (so-called watchful waiting), or should ablation of the HGD be done?…