Prophylactic esophagectomy in Barrett esophagus with high-grade dysplasia.

Abstract

We review the significance of Barrett mucosa with high-grade dysplasia, management options, rationale for prophylactic esophagectomy, and results of surgical treatment. The surgical results of prophylactic esophagectomy are presented from two previous studies, involving 60 patients over 1982-2001 at a single institution. These results are compared with nonsurgical treatment options. The transhiatal esophagectomy technique was the most commonly used surgical approach (81.7% of patients). Operative mortality was 1.7%. The incidence of occult adenocarcinoma for 1982-1994 and 1994-2001 was 43% and 16.7%, respectively. The overall incidence of occult adenocarcinoma for the entire study period was 30%. Prophylactic esophagectomy for patients with Barrett esophagus and high-grade dysplasia, performed at a center of high volume and experience, can be accomplished with low mortality and excellent long-term survival. Incidence of occult adenocarcinoma is decreasing, but still 16.7-30%.