Esophagectomy Is Not Justified for Mucosal Neoplasia in Barrett Esophagus

Rates of detection of lymph node metastasis and mortality were each about 2% using esophagectomy.

Endoscopic ablation is increasingly used to treat high-grade dysplasia (HGD) and intramucosal carcinoma (IMC) in patients with Barrett esophagus (BE). Although this approach is highly effective, it cannot cure cancers that have metastasized to lymph nodes. Endoscopic mucosal resection (EMR) — the standard of care for T staging to guide further treatment of these patients — unfortunately cannot always detect lymph node involvement. As such, many surgeons recommend esophagectomy instead of EMR and ablation, citing high rates of unexpected lymph node metastasis. However, reported rates of metastasis have varied widely.

To estimate the frequency of lymph node metastases in patients with BE and HGD or IMC, investigators performed a systematic rev…

Reviewing Author

David A. Johnson, MD

Disclosures

Consultant/Advisory boardMedscape/WebMD; Pfizer; CRH Medical Corporation; Aries

EquityCRH Medical Corporation

Editorial boardsMedscape Gastroenterology

Leadership positions in professional societiesAmerican College of Gastroenterology Research Institute Board of Directors

David A. Johnson, MD

Disclosures

Consultant/Advisory boardMedscape/WebMD; Pfizer; CRH Medical Corporation; Aries

EquityCRH Medical Corporation

Editorial boardsMedscape Gastroenterology

Leadership positions in professional societiesAmerican College of Gastroenterology Research Institute Board of Directors