HP14 EVOLVING MANAGEMENT OF HIGH GRADE DYSPLASIA IN BARRETT'S OESOPHAGUS

Abstract

Background: High grade dysplasia (HGD) in Barrett's oesophagus is a pre‐cancerous condition, where oesophagectomy eliminates the risk of malignancy but can incur significant morbidity. Endoscopic therapies and expectant surveillance have been increasingly adopted. Given that the timing of malignant transformation cannot be predicted, the optimal treatment for HGD is unclear and is evolving. This study aims to evaluate the outcome of a cohort of patients with HGD in Barrett's oesophagus.Methodology: There were 84 patients with biopsy‐proven HGD treated at our institution between 3/1992 and 12/2008 documented prospectively onto a database. Records were reviewed for patient characteristics, presence of occult cancer, treatment and outcomes including operative mortality and morbidity, and malignant transformation.Results: The primary treatment was oesophagectomy in 48 patients, endoscopic mucosal resection (EMR)/ablation in 18 and observation in 18. Following oesophagectomy, 19 (40%) had an occult invasive carcinoma. Following endoscopic therapy, (median FU 36 months), 2 patients were diagnosed with cancer requiring resection. In those patients observed, due to co‐morbidity or patient's choice, (median FU 74 months) 9 (50%) developed malignancy leading to resection (6), EMR (1) and radiotherapy (2). Following resection there was 1 death (2%) with 34 patients (62%) having a complication.Conclusion: Resection of HGD is a curative treatment but post‐operative morbidity is not insignificant. Medium term outcome data for endoscopic therapies is encouraging but patients need long term careful follow‐up. Patients with HGD need to be fully informed of the different treatment options and their limitations.