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 Risk of progression to cancer (per year) Recommended management
Negative for dysplasia 0.2-0.5% Repeat endoscopy in 3-5 years
Atypia indefinite for dysplasia Unknown Repeat endoscopy in 3-6 months after optimization of acid suppression
If still indefinite for dysplasia, follow up in 12 months
Low-grade dysplasia (precancerous change) 0.7% Expert confirmation of diagnosis and endoscopic treatment
Repeat endoscopy every 6 months in the first year after diagnoses, then annually
High-grade dysplasia
(severe precancerous change)
~7% Expert confirmation of diagnosis and endoscopic treatment
Repeat endoscopy every 3 months in the first year after diagnosis, every 6 months in the second year, then annually

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Reference:

1. Shaheen NJ, Falk GW, Iyer PG, Gerson LB; American College of Gastroenterology. ACG Clinical Guideline: Diagnosis and Management of Barrett's Esophagus. Am J Gastroenterol. 2016 Jan;111(1):30-50.