AGA Clinical Practice Update: Diagnosis and Management of Low-Grade Dysplasia in Barrett’s Esophagus.
The information provided by the AGA Institute is not medical advice and should not be considered a replacement for seeing a medical professional.
What is low-grade dysplasia?
- After finding Barrett’s esophagus, your doctor will do a biopsy (taking a small piece of tissue to look at under a microscope) to check how bad the disease is.
- The biopsy may show that the cells in your esophagus have become more abnormal, also known as dysplasia (a stage between Barrett’s Esophagus and cancer).
- Just because the cells are abnormal does not mean they are cancerous.
- There are two grades of dysplasia based on the abnormality of the cells seen under a microscope:
– Low-grade dysplasia- High-grade dysplasia
- Low-grade dysplasia (LGD) means that some of the cells looked abnormal when seen under a microscope.- Even if the cells look cancerous, they are not able to spread throughout the body.- This is looked at as the earlier form of pre-cancer of the esophagus.
- High-grade dysplasia (HGD) means that some of the cells look very abnormal under the microscope and are getting closer to cancer.- This is looked at as a more advanced pre-cancer of the esophagus.
Treatment for LGD
- Your will do another endoscopy after the dysplasia has been graded as low (LGD), to get more biopsies of the esophagus to make certain that the condition is not something worse.- This should be done within 8-12 weeks once the acid reflux symptoms are under control.
- LGD can go away on its own or by simply treating the reflux with a type of drug called proton pump inhibitors, or PPIs for short.
- Keeping a healthy, balanced diet and limiting certain foods can also help lessen reflux in patients with LGD.
- Patients with LGD may get routine biopsies to make sure the dysplasia does not get worse.
- If the dysplasia goes away, endoscopy does not have to be done as often, but patients need to stay on PPIs.
- Any dysplasia that is found during the endoscopy should be followed up with endoscopic surveillance (keeping an eye on the area) twice within the first year, and then once a year after that.
- In some patients, dysplasia may not go away with acid reflux drugs.
- To avoid cancer or the need for serious surgery, a doctor may suggest endoscopic eradication therapy (EET).- Endoscopic resection (ER) – This tool removes larger and deeper tissue samples using the endoscope. ER should be performed in patients with clear abnormalities visible during endoscopy for a more accurate assessment of the dysplasia.- In ER, only the most suspicious areas are removed for further testing.- A doctor may follow this up with a treatment called radiofrequency ablation to get rid of any leftover dysplasia.
- Radiofrequency ablation (RFA)
During RFA, radio waves are sent through a flexible, thin tube (called a catheter) to the esophagus to remove and kill abnormal Barrett’s tissue with the least amount of harm to the healthy tissue.- Most often, three to four weeks after the RFA treatment, the diseased tissue is replaced by healthy tissue.
- After EET, the AGA recommends regular endoscopies to keep an eye on the esophagus and make sure the dysplasia does not return or turn into cancer.- Patients who had complete eradication of LGD should get an endoscopy each year for two years, and then every three years after that.- Patients who did not have a complete eradication of LGD should get an endoscopy twice within the first year, then every year for two years, and then every three years after that.
- If BE progresses to cancer, your doctor may consider surgery to remove parts of the esophagus and stomach to stop the cancer from spreading.
- In some patients, a fundoplication, a surgery that can control the reflux, is performed instead of, or in addition to, PPIs.