Surgery or endotherapy for high-grade dysplasia/early adenocarcinoma in Barrett's oesophagus?

The incidence of oesophageal adenocarcinoma is increasing and Barrett's oesophagus (columnar-lined oesophagus) is the main risk factor. Currently, oesophagectomy for oesophageal adenocarcinoma is the only accepted effective therapy; however, it has significant associated morbidity and mortality. Recent developments in the staging of oesophageal adenocarcinoma have allowed early adenocarcinoma/high-grade dysplasia to be identified with confidence, allowing attempts at local endoscopic treatment without the need for oesophagectomy. Hitherto, there have been no reports of long-term follow-up. Follow-up of local endoscopic therapy in 115 patients with high-grade dysplasia/early adenocarcinoma has now been presented, suggesting that local endoscopic therapy appears to be an effective and safe option for the management of these conditions.