Abstract
BACKGROUND: The treatment of high-grade intraepithelial neoplasia (HG-IN) within Barrett's oesophagus (BOe) is controversial. METHODS: Herein we highlight current data on HG-IN and evaluate adequacy of various treatment strategies (observation, ablation, resection). RESULTS: HG-IN within BOe has clearly (pre-)malignant character, is frequently multifocal and often already associated with synchronous invasive oesophageal (Barrett's) adenocarcinoma. Establishment of the diagnosis is challenging, due to substantial endoscopic 'sampling error' (even with new technologies like chromo- or magnification endoscopy) and 'intra-/interobserver variability' distinguishing different forms of intraepithelial neoplasia and early invasive carcinomas. Regarding the treatment of choice for this condition, there is plenty of evidence to suggest that an oncologically adequate approach should be chosen, including removal of the entire precancerous BOe and regional lymphadenectomy. CONCLUSIONS: Surgical resection is the 'treatment of choice' for BOe harbouring HG-IN. Limited resection of the oesophagogastric junction is superior to radical oesophagectomy, endoscopic mucosa resection, ablation or observational strategies.
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