Intramucosal Esophageal Cancer and High-Grade Dysplasia: Which Treatment Frame the Debate

Excerpt

Surgical therapy or endoscopic therapy: which is best for the treatment of high-grade dysplasia (HGD) and intramucosal (IM) adenocarcinoma of the esophagus? This is a reasonably recent debate, one that did not exist 5–10 years ago. Even today, surgical textbooks suggest esophageal resection as the appropriate treatment for this disease.1 Debating this question is important yet difficult because the treatments are so different with different risk and benefit profiles. As with any therapy, every treatment has a risk/benefit ratio that must be taken into account when deciding the appropriate therapy. An example of this is shown in Fig. 1, suggesting a theoretical risk–benefit plot today versus 10 years ago. With improvements in staging, morbidity associated with esophageal resection and the rapid increase in available endoscopic ablative and resection techniques both have a role and we need to understand their current and ever-changing place in the armamentarium of treatment. So how does the debate lay out?

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