High Grade Dysplasia

Husband diagnosed barretts/High grade dysplasia PET shows no cancer.Treatment-Ivor Lewis Surgery.49 yrs old good health no smoker or drinker. need to know opinion on alternative treatments
Complications for laser etc.-10 yrs ago had hiatal hernia repair
severe case according to doctor. Have read all and am confused.
some statements of no cancer developing from high grade dysplasia. Are endoscopies and ablation too risky, does cancer spread to fast when and if developes.after surgery can he lead a normal life? eat as before? Are options just prolonging the inevitable? Dysplasia in esophagus and stomach. partial stomach will be removed. treatment at UAB B'Ham, Al. Exellent Dr. If a candidate for alternative treatment is it risky also? Long term side affects if he has surgery? Owns lawn service still be able to work as normal? Would appreciate any information you can offer . We are looking at all options before we make a decision.
Know of controversy between surgery and other options. Just confused because there is no cancer. Need guidance in making a wise decision. Thank you for your help!!

[Kevin Pho, MD]

Surgery for high-grade dysplasia is an accepted treatment course, as this is the only way that clearly removes all of the affected cells.  However, this procedure has the highest complication rate - including a mortality rate of about 3 percent.

Non-surgical options would include photoablative therapy and endoscopic mucosal resection.  Regarding the first option - esophageal stricture is common (40 percent of cases) - with no long-term data regarding the eradication of the affected tissue.

Data is also limited for mucosal resection - this is more in the investigational stage and can be discussed with your gastroenterologist.

The third option is intensive endoscopic surveillance.  

There are no clear guidelines.  Generally, the risks of an esophagectomy has to be weighed against the benefits.  In general, in young, healthy patients, esophagectomy is the recommended course of action.  

These options should be discussed with your personal physician.  Another gastroenterology opinion should be sought if there is question about the treatment course.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_

[celine149]

The reason they suggest esophagectomy with HGD is because in many people with HGD it is determined that there is an underlying cancer. It just was not detected prior to surgery. If you visit the "John Hopkins Barrett's Esophagus discussion board' you will get alot of answers. There are several on that board that has had Esophagectomies for HGD as well as some that has had PDT for treatment of HGD. They are very willing to share their experiences and recovery with people facing the same choices.