Management of High-Grade Dysplasia and Intramucosal Adenocarcinoma in Barrett's Esophagus

Clinical Scenario A Caucasian male with chronic long-standing gastroesophageal reflux disease and a history of nondyslastic Barrett’s esophagus (BE) undergoes surveillance upper ndoscopy with biopsies at an outside facility. Biopsies revealed igh-grade dysplasia (HGD) and the patient is referred to a ertiary care referral center for endoscopic eradication therapy EET). His symptoms are adequately controlled on twice daily roton pump inhibitor therapy, and he denies any alarm sympoms. His physical examination is unremarkable with the exeption of mild obesity. Repeat endoscopy revealed proximal isplacement of the squamocolumnar junction by 4 cm above he most proximal extent of the gastric folds (circumferential egment, 2 cm; maximal extent, 4 cm; Prague C2M4) and a edium-sized sliding hiatal hernia. The BE segment was careully inspected with standard white light high-resolution enoscopy and narrow band imaging (NBI). Although no obvious isible lesions were identified, an area of abnormal mucosal and ascular pattern was detected with NBI. Endoscopic mucosal esection (EMR) of this area was performed and pathology was onsistent with intramucosal esophageal adenocarcinoma IMC) with negative deep and lateral margins confirmed by 2 xpert gastrointestinal pathologists. Random surveillance biopies were obtained from the remaining Barrett’s segment that howed intestinal metaplasia with no dysplasia. How should ou counsel this patient with Barrett’s esophagus and IMC egarding therapeutic options? What are the treatment options o achieve endoscopic eradication of BE? What are the compliations of EET and how should this patient be followed after reatment?