Editing Barrett's oesophagus (section)

=== '''High-grade     dysplasia''' ===

** Review slides with      experienced pathologist
** '''Indication      for intervention'''      - ideally RFA
** Most get endoscopic therapy,      followed by surveillance gastroscopy three months later
** Careful repeat biopsy - look      out for focus of invasive carcinoma - use every imaging modality      available - white light, NBI, acetic acid
** Small lesions - endoscopic      resection - ideally take full thickness of mucosa and submucosa
** Can evaluate lesions larger      than 1-2cm for invasion using EUS - key point would be whether it is T1a      or T1b
** '''If HGD or      T1a (without LVI), options are oesophageal preservation therapy vs      oesophagectomy'''
*** Oncologically equivalent,       but long-term surveillance and multiple initial scopes required, and       recurrence is a risk
*** Oesophagectomy historically       gets good results in this group, with mortality under 1%
*** However, endoscopic       treatment and surveillance is much better now