[Early Barrett's carcinoma/high grade intraepithelial neoplasia (HG-IEN): pro endoscopic treatment--pro surgical treatment].

Who may treat early Barrett's carcinoma of the oesophagus? The incidence of adenocarcinoma of the oesophagus developing within Barrett's mucosa has substantially risen in the past few years. Furthermore, treatment of preneoplastic lesions or early carcinoma is controversial. From an endoscopist's point of view high-grade intraepithelial neoplasia (HG-IEN) should be resected endoscopically rather than destroyed endoscopically while early Barrett's carcinoma should undergo endoscopic staging resection. Surgical resection is rarely necessary because lymph node metastases are rare and there is some morbidity and mortality associated with the procedure. However, surgeons argue that complete surgical resection is required because no imaging technique reveals the exact extent of the lesion and, ultimately, the degree of infiltration can only be determined within the resected specimen. Also, only surgical procedures may remove all potentially involved regional lymph nodes. Furthermore, only within surgical resections we can eliminate all pre-existing Barrett's mucosa easily while endoscopic clearance of Barrett's mucosa is difficult and requires multiple sessions. The Merendino-Siewert procedure may be an option with very low morbidity and mortality. It is worthy of note that new endoscopic resection procedures have not been studied in a controlled fashion against conventional surgical procedures. Therefore, patients with HG-IEN or early Barrett's carcinoma of the esophagus should be recruited into controlled studies and be treated in specialised high-volume centres.