Management of dysplasia in the columnar-lined esophagus

Dysplasia is a morphologic intermediate in the multistep neoplastic progression of esophageal columnar metaplasia to adenocarcinoma. The management of patients with this diagnosis is complex and controversial with regard to electing continued endoscopic biopsy surveillance until an early cancer is detected or proceeding with partial esophagogastrectomy. Clinical recommendations to patients for either option should be individualized and based on several parameters reflecting patient and clinician factors. Ongoing research goals are to improve the ability to detect dysplasia and other precancerous abnormalities in the columnar-lined esophagus, to identify new treatment modalities that are as effective as, but safer than, surgical resection, and to develop therapeutic strategies that may prevent, stop, or slow the development of these lesions.