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

 High-grade dysplasia and early adenocarcinoma can now be staged accurately with intensive biopsy protocols, endoscopic ultrasound and computed tomography. Local endoscopic therapy appears to be an effective therapy and safer than surgery. Rigorous follow-up is required because of new lesions occurring after successful treatment. 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.