Is Mucosal Eradication an Effective Intervention for Barrett Esophagus with Dysplasia?

Dysplastic Barrett esophagus carries a risk of progressing to esophageal adenocarcinoma, generally via the stages of low-grade dysplasia and high-grade dysplasia. Depending on the presence of cancer or dysplasia, management strategies include esophagectomy, endoscopic eradication therapy, and endoscopic surveillance. This chapter reviews the current evidence for the various management strategies for both patients with low-grade dysplasia and high-grade dysplasia. Despite low-quality comparative evidence on esophagectomy versus endoscopic eradication therapy for Barrett esophagus with high-grade dysplasia, endoscopic eradication therapy is the recommended treatment instead of esophagectomy. For Barrett esophagus with low-grade dysplasia high-quality evidence is available. For this indication endoscopic eradication therapy should be discussed as an alternative to endoscopic surveillance, taking risk and benefits of both approaches into account.