Center for Minimally Invasive Esophageal Therapies
Diseases & Conditions
At Boston Medical Center we pride ourselves on our ability to diagnose and treat esophageal disorders, including high-grade dysplasia of the esophagus, using the most advanced therapies. We do so in a caring and compassionate enviornment, where our priority is the well-being of you and your family.
What is High-Grade Dysplasia of the Esophagus?
High grade dysplasia (HGD) refers to precancerous changes in the cells of the esophagus. Gastroesophageal reflux disease (GERD) can be complicated by Barrett’s esophagus (BE), a change in the normal esophageal cells to intestinal-like cells. BE cells can become abnormal or dysplastic. Low grade and then high grade dysplasia can develop. HGD significantly increases a person’s risk for esophageal adenocarcinoma and in most cases will progress to cancer without any treatment. When someone is diagnosed with HGD, an intervention is advised including endoscopic resection and Barrx ablation or in some cases an esophagectomy is recommended for treatment.
You may not experience any symptoms, but they can include:
- You are unlikely to experience symptoms from HGD specifically. A loss of your heartburn symptoms from GERD, can suggest Barrett’s esophagus has developed (although you can have heartburn and BE). HGD occurs in the setting of BE; thus, HGD would be found on an endoscopy for GERD or BE surveillance .
- If you have trouble swallowing, this suggests the dyplasia has progressed to cancer.
Diagnosis is often difficult, as symptoms may be limited.
- Endoscopy. The physician will spray a pain-killing solution in your throat. You will receive intravenous pain medication and sedation, then the surgeon or gastroenterologist will examine your esophagus with an endoscope (EGD), which is a thin, lighted tube with a tiny camera at the end. The physician will be able to view any abnormalities and take a tissue samples (biopsies). The pathologist will look at the biopsy tissues under the microscope to make a diagnosis of high grade dysplasia.
There are a variety of ways we can treat your high-grade dysplasia. Your physician will work with you and your family to decide the most appropriate course of action. Your options include:
- Endoscopic Resection (ER). This treatment involves using an endoscope and special tools to lift and cut abnormal lesions or tumors from the esophageal lining. Interpretation of the ER specimen by the pathologist will help determine whether the HGD has been removed and treated or whether the HGD was actually an early esophageal cancer because of deeper involvement of the esophageal lining.
- Barrx or Radiofrequency ablation. Barrx is another procedure done with an endoscope, in which BE and dysplasia in the esophagus can be burned and then replaced with what appear to be normal esophageal cells.
- Esophagectomy. Esophagectomy is the surgical removal of all or part of the esophagus, and is usually reserved for only the highest risk cases including patients with multifocal high grade dysplasia, young patients who may not wish to undergo a lifetime (decades) of endoscopic surveillance, repeat procedures and concerns about esophageal cancer development, or in patients in whom a diagnosis of cancer cannot be excluded.
- Photodynamic therapy. Photodynamic surgery is used to treat dysplasia and BE, although it has been replaced primarily by Barrx ablation for BE and dysplasia. For PDT you will receive an injection of a light-sensitive drug that remains in cancer-like cells longer than in healthy cells and then you undergo an endoscopy and laser treatment of the esophageal lining.