Dysplasia is a precancerous condition in which cells which are very similar to cancer cells grow in an organ but have not yet acquired the ability to invade into tissue or metastasize (spread to areas distant from where they started). This is a stage which can be cured.

Any degree of dysplasia in Barrett's esophagus is a risk factor for developing esophageal cancer (adenocarcinoma). However, high-grade dysplasia has an increased risk of progression to cancer compared to low-grade dysplasia. Pathologists can diagnose and grade dysplasia by looking at esophageal biopsies under the microscope.

"Indefinite for dysplasia" means that the cells look atypical under the microscope, but it is unclear whether the cells are truly dysplastic or not. This can happen in certain situations, such as when the esophagus has been injured (for instance, due to inflammation or an ulcer).

The table below shows the risk of progression to esophageal cancer and recommended management for Barrett's esophagus with varying degrees of dysplasia, based upon guidelines developed by the American College of Gastroenterology. [1]

Degree of Dysplasia Recommended Management
Negative for dysplasia Repeat endoscopy in 3-5 years
Indefinite for dysplasia Diagnostic confirmation by expert GI pathologist
Maximize acid suppression
Repeat EGD within 6 months
Low grade dysplasia Diagnostic confirmation by expert GI pathologist
Discuss endoscopic treatment versus surveillance:
- Endoscopic treatment, followed by surveillance in 1 year, then every 2 years OR
- Surveillance every 6 months for the first year, then annually
High grade dysplasia Diagnostic confirmation by expert GI pathologist
Endoscopic treatment
Surveillance at 3, 6, and 12 months, then annually

Reference:

Shaheen NJ, Falk GW, Iyer PG, Souza RF, Yadlapati RH, Sauer BG, Wani S. Diagnosis and Management of Barrett's Esophagus: An Updated ACG Guideline. Am J Gastroenterol. 2022 Apr 1;117(4):559-587.

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