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World J Gastrointest Pathophysiol. May 15, 2014; 5(2): 91-99
Published online May 15, 2014. doi: 10.4291/wjgp.v5.i2.91
Low grade dysplasia in Barrett’s esophagus: Should we worry?
Vamshi P Jagadesham, Clive J Kelty
Vamshi P Jagadesham, Clive J Kelty, Department of Upper Gastrointestinal Surgery, Northern General Hospital, Sheffield S5 7AU, United Kingdom
Author contributions: Jagadesham VP and Kelty CJ contributed equally to this paper.
Correspondence to: Clive J Kelty, PhD, FRCS, Department of Upper Gastrointestinal Surgery, Northern General Hospital, Herries Rd, Sheffield S5 7AU, United Kingdom. clive.kelty@sth.nhs.uk
Telephone: +44-114-3052291 Fax: +44-114-3052307
Received: December 27, 2013
Revised: February 11, 2014
Accepted: April 9, 2014
Published online: May 15, 2014
Processing time: 143 Days and 20.3 Hours
Abstract

The optimal management for low-grade dysplasia (LGD) in Barrett’s esophagus is unclear. In this article the importance of LGD is discussed, including the significant risk of progression to esophageal adenocarcinoma. Endoscopic surveillance is a management option but is plagued by sampling error and issues of suboptimal endoscopy. Furthermore endoscopic surveillance has not been demonstrated to be cost-effective or to reduce cancer mortality. The emergence of endoluminal therapy over the past decade has resulted in a paradigm shift in the management of LGD. Ablative therapy, including radiofrequency ablation, has demonstrated promising results in the management of LGD with regards to safety, cost-effectiveness, durability and reduction in cancer risk. It is, however, vital that a shared-decision making process occurs between the physician and the patient as to the preferred management of LGD. As such the management of LGD should be “individualised.”

Keywords: Low grade dysplasia; Barrett’s esophagus; Endoluminal therapy; Radiofrequency ablation; Esophageal adenocarcinoma

Core tip: Low-grade dysplasia (LGD) in Barrett’s esophagus (BE) is an important entity and poses a significant risk of progression to esophageal adenocarcinoma. With the emergence of endoluminal therapy over the past decade there has been a paradigm shift in the management of LGD. Ablative therapy, such as radiofrequency ablation, has demonstrated promising results in the management of LGD with regards to safety, cost-effectiveness, durability and reduction in cancer risk. It is, however, critical that management should be through a shared-decision making process and “individualised”. It is our belief that physicians should “worry” about LGD in BE.