IC: intramucosal carcinoma; EAC: esophageal adenocarcinoma; PPI: proton pump inhibitor; LGD: low-grade dysplasia; HGD: high-grade dysplasia.
* The pathologists should have expertise in esophageal histopathology.
¶ The choice of treatment will depend on the patient's overall health and the stage of the cancer, and may include chemoradiotherapy with or without esophagectomy, or even endoscopic resection in highly selected cases.
Δ Subsequent management will depend on whether dysplasia is present on surveillance biopsies.
◊ The length of the nondysplastic Barrett's segments generally informs the intervals for endoscopic surveillance. Patients with longer segments (≥3 cm) undergo surveillance every three years, whereas patients with shorter segments (<3 cm) undergo surveillance every five years.
§ If the biopsies again are indefinite for dysplasia, initiate surveillance every 12 months or refer the patient to a center that specializes in the management of patients with Barrett's esophagus.
¥ Options for endoscopic eradication therapy include radiofrequency ablation and spray cryotherapy. The choice of therapy will depend on local expertise. Esophagectomy is an alternative if endoscopic eradication therapy is not available.
‡ Patients who do not undergo endoscopic eradication should undergo endoscopic surveillance every 6 months for one year with biopsies obtained at 1 cm intervals and then annually until there is reversion to nondysplastic Barrett's.