Radiofrequency ablation for low-grade dysplasia in Barrett's esophagus.

Abstract

The diagnosis and management of low-grade dysplasia (LGD) in Barrett's esophagus continue to evolve and vary in practice. Radiofrequency ablation (RFA) is now an acceptable option for the treatment of LGD. Therefore, the purpose of this review article is to present current literature on the diagnosis and management of LGD, and to explore when to optimally pursue RFA for the treatment of LGD. The challenge of the management of LGD begins with its diagnosis. Because of high interobserver variability among pathologists in the diagnosis of dysplasia, it is recommended that an expert gastrointestinal pathologist confirms the diagnosis of LGD. Endoscopic mucosal resection is indicated to remove visible lesions in the setting of dysplasia to obtain an accurate diagnosis, especially regarding T staging. Management options include intense surveillance and endoscopic eradication therapy. RFA provides a reasonable method to eradicate flat Barrett's mucosa. Endoscopic eradication of confirmed LGD has been demonstrated to reduce the risk of progression to esophageal cancer. Additional data about the risk factors associated with progression, and the benefits and risks of treatment are discussed, and can be incorporated in patient counseling and decision making. Endoscopic eradication therapy with RFA may be an appropriate treatment option for LGD in Barrett's esophagus after the benefits and risks have been discussed in detail with the patient.