Low grade dysplasia in Barrett’s esophagus: Should we worry?

Abstract

The optimal management for low-grade dysplasia (LGD) in Barrett's esophagus is unclear. In this article the importance of LGD is discussed, including the significant risk of progression to esophageal adenocarcinoma. Endoscopic surveillance is a management option but is plagued by sampling error and issues of suboptimal endoscopy. Furthermore endoscopic surveillance has not been demonstrated to be cost-effective or to reduce cancer mortality. The emergence of endoluminal therapy over the past decade has resulted in a paradigm shift in the management of LGD. Ablative therapy, including radiofrequency ablation, has demonstrated promising results in the management of LGD with regards to safety, cost-effectiveness, durability and reduction in cancer risk. It is, however, vital that a shareddecision making process occurs between the physician and the patient as to the preferred management of LGD. As such the management of LGD should be "individualised." Core tip: Low-grade dysplasia (LGD) in Barrett's esophagus (BE) is an important entity and poses a significant risk of progression to esophageal adenocarcinoma. With the emergence of endoluminal therapy over the past decade there has been a paradigm shift in the management of LGD. Ablative therapy, such as radiofrequency ablation, has demonstrated promising results in the management of LGD with regards to safety, costeffectiveness, durability and reduction in cancer risk. It is, however, critical that management should be through a shared-decision making process and "individualised". It is our belief that physicians should "worry " about LGD in BE.Jagadesham VP, Kelty CJ. Low grade dysplasia in Barrett's esophagus: Should we worry? World J Gastrointest Pathophysiol 2014; 5(2): 91-99 Available from:

Assessment of Narrow-Band Imaging Algorithm for Video Capsule Endoscopy Based on Decorrelated Color Space for Esophageal Cancer: Part II, Detection and Classification of Esophageal Cancer

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Systematic review and meta-analysis of the effectiveness of radiofrequency ablation in low grade dysplastic Barrett’s esophagus

“…Other endoluminal techniques are available and offer alternative vectors in the management of dysplastic and non-dysplastic BE. EMR is used to target visible abnormalities (nodular BE) [30], but there are no recommendations with regard to its use in the management of LGD, especially in the absence of nodular abnormalities [31]. EMR was used in three of the studies in this review [16,19,20].…”

Multispectral light scattering endoscopic imaging of esophageal precancer

“…There is widespread acceptance that Barrett’s esophagus with HGD should be treated endoscopically using various ablative therapies, which now have superb outcomes 5 . Some groups also advocate treating Barrett’s with LGD, although the rate of cancer progression in untreated LGD patients is still a matter of ongoing investigation 6 .…”