Low-grade dysplasia on Barrett’s esophagus: visible or not ?

Abstract

Current management of Barrett's esophagus (BE) relies on endoscopic follow-up of non-dysplastic BE, endoscopic resection of visible lesions, and ablation of flat dysplastic or residual BE. Indeed, so-called "visible lesions" arising in BE, mainly consisting of Paris 0-IIa and 0-IIb lesions, harbor early adenocarcinoma in 57% to 63% of cases, justifying endoscopic resection for adequate tumor staging [1,2]. While high-grade dysplasia (HGD) without any visible lesion is exceedingly rare, low-grade dysplasia (LGD) has long been considered endoscopically indistinguishable from non-dysplastic BE. Actually, LGD is observed in 7% to 8% of endoscopic resection specimens [1, 2], suggesting that a certain proportion of BE with low-grade dysplasia is actually visible.In this issue of Endoscopy International Open, Tony He et al.