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Report From STS Workforce on Evidence Based Surgery

The Society of Thoracic Surgeons Practice Guideline Series: Guidelines for the Management of Barrett's Esophagus With High-Grade Dysplasia

^a Boston University School of Medicine and Department of Cardiothoracic Surgery, Boston Medical Center, Boston, Massachussetts
^b Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
^c Stanford University School of Medicine, Stanford, California
^d Department of Thoracic and Cardiovascular Surgery University of Texas MD Anderson Cancer Center, Houston, Texas
^e Division of Cardiovascular Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
^f Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Denver, Colorado
^g University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
^h The Society of Thoracic Surgeons, Chicago, Illinois
ⁱ Division of Thoracic and Foregut Surgery, Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York

^_* Address correspondence to Dr Fernando, Department of Cardiothoracic Surgery, Boston Medical Center, 88 E Newton St, Robinson B402, Boston, MA 02118 (Email: hiran.fernando{at}bmc.org).

The management of Barrett's esophagus with high-grade dysplasia is controversial. The standard of care has traditionally been esophagectomy. However, a number of treatment options aimed at esophageal preservation are increasingly being utilized by many centers. These esophageal-sparing approaches include endoscopic surveillance, mucosal ablation, and endoscopic mucosal resection. In this guideline we review the best evidence supporting these commonly used strategies for high-grade dysplasia to better define management and guide future investigation.