Ask Dr. H: Removing noncancerous esophagus

Question:

My good friend was diagnosed with Barrett's esophagus and "high grade dysplasia." To his horror, the specialist is advising surgery to remove his esophagus - even though he doesn't even have cancer. That makes no sense to me. Can you give your thoughts on this?

Answer: The recommendation to surgically remove a noncancerous esophagus is an extreme and controversial one. High grade dysplasia is severely abnormal but noncancerous tissue that is likely to become cancerous. Two reasons to do this are: (1) Many patients with high grade dysplasia who had esophagus removal actually had cancer in their esophagus that was missed by upper endoscopy and biopsy, surgical studies report; and (2) Esophageal cancer is very curable if detected in an early stage, but much less curable when it's larger and deeper.

The approach is controversial because many patients with high grade dysplasia do not ever develop cancer. In one large study, patients with high grade dysplasia had just a 31 percent to 59 percent chance of developing cancer over five years. In another large study, 85 percent of folks with high grade dysplasia were cancer-free for eight years.

Many Barrett's experts are now recommending less invasive endoscopic procedures to destroy abnormal tissue. These include laser treatment and endoscopic spray cryotherapy with regular and frequent endoscopic surveillance for cancer or dysplasia.