Management of low-grade dysplasia in Barrett’s esophagus: Ablate or survey?

There are several issues that continue to make the management of Barrett’s esophagus and low-grade dysplasia challenging especially in terms of determining the optimal management strategy—surveillance vs endoscopic eradication therapy (EET). Some of these include a highly variable rate of neoplastic progression to high-grade dysplasia or cancer and significant interobserver variability among pathologists (including expert gastrointestinal pathologists). The efficacy and effectiveness of EET, predominantly using radiofrequency ablation, in reducing the risk of progression has been well described. However, there are limited data that define the ideal candidates most likely to benefit from EET compared with surveillance. This review discusses the challenges in the diagnosis and management of Barrett’s esophagus with low-grade dysplasia, provides practice advice for this patient population and the need for physicians to incorporate quality indicators in clinical practice.