Surgery versus radical endotherapies for early cancer and high grade dysplasia in Barrett's oesophagus

Abstract

This Cochrane review has indicated that there are no randomised control trials to compare management options in this vital area, therefore trials should be undertaken as a matter of urgency. The problems with such randomised methods are standardising surgery and endotherapies in all sites; standardising histopathology in all centres; assessing which patients are fit or unfit for surgery; and making sure there are relevant outcomes for the study i.e. long term survival (over five or more years) and no progression of high grade dysplasia.

Predictors of Lymph Node Metastasis in Surgically Resected T1 Esophageal Cancer

“…Barrett mucosa is controversial [1]. Although radical esophagectomy and extended lymphadenectomy are still considered the gold standard in treating early esophageal neoplasia by many centers, less invasive endoscopic approaches are increasingly propagated despite some serious concerns about the oncologic adequacy of these methods and the lack of high-level evidence [2]. Theoretically, endoscopic mucosal resection (EMR) embodies the long sought after, ideal treatment of early cancer.…”

Management of Barrett esophagus: a practical guide for clinicians based on the BADCAT and BoB CAT recommendations

“…[36][37][38][39][40][41][42] Pathological diagnosis and staging To ensure accurate reporting of BE and dysplasia, it is recommended that in benign cases there is little uncertainty in diagnosis with the reliance on only 1 trained gastrointestinal pathologist. However, when any degree of dysplasia is suspected, at least 2 trained specialist gastrointestinal pathologists are needed to ascertain the severity of the lesion.…”

Endoscopic therapies for the prevention and treatment of early esophageal neoplasia

“…There are no randomized controlled trials comparing esophagectomy to endotherapies in HGD/EC [112]. With a lack of good evidence, therapy may be unduly influenced by the personal bias of the treating clinician.…”