@entity355 is a common @entity558 that results from chronic @entity354 . High grade @entity1141 in the metaplastic esophagus is thought to be the last step in the metaplasia-to- @entity189 sequence that characterizes this disease. The management of high grade @entity1141 in @entity355 is controversial. Some investigators advocate a rigorous endoscopic surveillance program with biopsies, but this approach has been questioned because of its clinical impracticality, high cost, possibility of sampling errors, and difficulty demonstrating effectiveness on a reproducible basis. Others advocate mucosal ablative therapy to eradicate the @entity6349 and metaplastic epithelium. This approach, still in its infancy, cannot be accepted as standard therapy at the present time because of limited follow-up, its questionable ability to completely eradicate the abnormal mucosa, the phenomenon of pseudoregression, and the @entity1 require continued rigorous endoscopic surveillance. Esophagectomy, on the other hand, can be accomplished with a low mortality rate in these @entity1 . We advocate this approach because a large number of them have @entity3 in the esophagus despite a preoperative diagnosis of only high grade @entity1141 . In addition, the 5-year survival is excellent even if @entity3 is present, and these @entity1 are liberated from rigorous endoscopic surveillance for the rest of their lives. For @entity1 with high grade @entity1141 in @entity355 who are poor operative risks, less invasive approaches such as @entity33 may play a role, but longer follow-up information is needed before this technique can be accepted even in this setting.

High grade @entity1141 : surveillance, XXXX , or resection?

@entity1 :: ('9606', 'Species') :: ['patients'] @entity558 :: ('MESH:C536528', 'Disease') :: ['premalignant condition'] @entity355 :: ('MESH:D001471', 'Disease') :: ["Barrett's esophagus"] @entity33 :: ('MESH:D052016', 'Disease') :: ['mucosal ablation'] @entity189 :: ('MESH:D002277', 'Disease') :: ['carcinoma'] @entity354 :: ('MESH:D005764', 'Disease') :: ['gastroesophageal reflux'] @entity3 :: ('MESH:D009362', 'Disease') :: ['invasive cancer'] @entity6349 :: ('MESH:D004416', 'Disease') :: ['dysplastic'] @entity1141 :: ('MESH:C535662', 'Disease') :: ['dysplasia']
@entity33 :: (MESH:D052016,Disease) :: ['mucosal ablation']
