8 Responses to “Barrett esophagus with high-grade dysplasia: How should it be staged?”
M. Brian Fennerty, MD
Founding Editor
NEJM Journal Watch Gastroenterology
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I perform EUS and would feel much safer staging with EUS first then performing EMR.
perfom RF abalation of nodule after EUS
I WILL RESECT THE NODULE AND STAGE WITH EUS ONLY IF INTRAMUCOSAL CARCINOMA OR GREATER NEOPLASIA IS SEEN
Option 3
Resect with EMR, and then only EUS if you are staging an invasive cancer. EUS often over- or under-stages mucosal lesions.
Dear Dr. Fennerty,
we perform EUS prior to resection only if a higher degree of invasive carcinoma is suspected. If not, I would rather go ahead with your second option to resect the nodule endoscopically and apply EUS later on only if a submucosal carcinoma or greater neoplasia is seen.
Best regards.
Stephan
Resect the nodule and stage with EUS only if intramucosal carcinoma or greater neoplasia is seen
I had exactly the patient you described 1 yea ago.
patient with barret’s of 2-3 cm. that was on surveillance for years. a nodule of 0,5 cm. appeared that was adenocarcinoma: I send him for EUS–> resection of the nodule–> and RFA OF THE BARRETT’S. until now he is o’kay. his age about 60 and very fat: high operation risk.