Expert Commentary: Surveillance Versus Ablation for Patients with Low-Grade Dysplasia

  • John G. Hunter
  • Joseph M. DrosdeckEmail author


The diagnosis and management of low-grade dysplasia (LGD) in the setting of Barrett’s esophagus continues to challenge physicians. Interobserver variability among pathologists remains high, and clinicians lack accurate models to predict those at risk of progressing to high-grade dysplasia and esophageal adenocarcinoma. Radiofrequency ablation (RFA) offers a safe and effective treatment option for LGD with acceptable risks, given the unpredictable natural course of the disease. Although current evidence suggests that RFA is cost-effective, long-term data is not yet available. However, patients experience an improvement in disease-specific health-related quality of life. Therefore, RFA should be considered in all patients with LGD.


Barrett’s esophagus Intestinal metaplasia Low-grade dysplasia Endoscopic ablation Radiofrequency ablation 


  1. 1.
    Vieth M. Low-grade dysplasia in Barrett’s esophagus – an innocent bystander? Contra. Endoscopy. 2007;39:647–9.CrossRefGoogle Scholar
  2. 2.
    Curvers WL, ten Kate FJ, Krishnadath KK, et al. Low-grade dysplasia in Barrett’s esophagus: overdiagnosed and underestimated. Am J Gastroenterol. 2010;105:1523–30.CrossRefGoogle Scholar
  3. 3.
    Kerkhof M, van Dekken H, Steyerberg EW, et al. Grading of dysplasia in Barrett’s oesophagus: substantial interobserver variation between general and gastrointestinal pathologists. Histopathology. 2007;50:920–7.CrossRefGoogle Scholar
  4. 4.
    Shaheen NJ, Falk GW, Iyer PG, Gerson LB, American college of G. ACG clinical guideline: diagnosis and management of Barrett’s esophagus. Am J Gastroenterol. 2016;111:30–50; quiz 1.CrossRefGoogle Scholar
  5. 5.
    Shaheen NJ, Sharma P, Overholt BF, et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med. 2009;360:2277–88.CrossRefGoogle Scholar
  6. 6.
    Shaheen NJ, Overholt BF, Sampliner RE, et al. Durability of radiofrequency ablation in Barrett’s esophagus with dysplasia. Gastroenterology. 2011;141:460–8.CrossRefGoogle Scholar
  7. 7.
    Phoa KN, van Vilsteren FG, Weusten BL, et al. Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia: a randomized clinical trial. JAMA. 2014;311:1209–17.CrossRefGoogle Scholar
  8. 8.
    Orman ES, Kim HP, Bulsiewicz WJ, et al. Intestinal metaplasia recurs infrequently in patients successfully treated for Barrett’s esophagus with radiofrequency ablation. Am J Gastroenterol. 2013;108:187–95; quiz 96.CrossRefGoogle Scholar
  9. 9.
    Orman ES, Li N, Shaheen NJ. Efficacy and durability of radiofrequency ablation for Barrett’s esophagus: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2013;11:1245–55.CrossRefGoogle Scholar
  10. 10.
    Hur C, Choi SE, Rubenstein JH, et al. The cost effectiveness of radiofrequency ablation for Barrett’s esophagus. Gastroenterology. 2012;143:567–75.CrossRefGoogle Scholar
  11. 11.
    Shaheen NJ, Peery AF, Hawes RH, et al. Quality of life following radiofrequency ablation of dysplastic Barrett’s esophagus. Endoscopy. 2010;42:790–9.CrossRefGoogle Scholar

Copyright information

© SAGES 2019

Authors and Affiliations

  1. 1.Department of SurgeryOHSUPortlandUSA
  2. 2.Department of General SurgeryThe Everett ClinicEverettUSA

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