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The new treatment paradigm for Barrett's dysplasia
  1. Laurence Lovat
  1. Correspondence to Professor Laurence Lovat, Department for Tissue & Energy, Division of Surgery & Interventional Science, UCL, UCLH, 67-73 Riding House Street, London W1W 7EJ, UK; l.lovat{at}

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You are diagnosed with localised cancer. What are your options? A small cancer can be entirely removed with surgery. If it is larger, after debulking, the tumour field is ablated using radiotherapy.

So what happens if you have precancerous change such as mucosal dysplasia arising in Barrett’s oesophagus? It should be easily curable. But sadly, until very recently, there was no local treatment. The doctor could offer regular endoscopic surveillance until cancer developed or perform oesophagectomy with its 30% morbidity rate and not insignificant mortality rate. Finally, the paradigm is changing.

The standard cancer treatment approach can be applied to Barrett's dysplasia. Debulking using endoscopic mucosal resection (EMR) followed by field ablation using radiofrequency ablation (RFA) has completely revolutionised treatment. Therapy is now performed as a day case and usually requires between two and three sessions spaced 2–3 months apart. There have been two randomised controlled trials (RCTs): one for both low-grade dysplasia (LGD) and high-grade dysplasia (HGD), and the second for LGD only. The first showed …

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