Endobrachyœsophage : place de la résection

Surgical resection has a limited place in the management of Barrett's oesophagus with high-grade dysplasia, except when failure of endoscopic mucosectomy is likely (extended Barrett's oesophagus, nodular or ulcerated lesions at endoscopy). For superficial carcinoma, it is often difficult to differentiate mucosal carcinoma (carrying a risk of nodal metastasis less than 7%) from submucosal carcinoma (carrying a risk of nodal metastasis ranging from 16 to 47%), oesophagectomy is routinely indicated if operative risk is low. When operative risk is not minimal, endoscopic mucosectomy is indicated for lesions limited to the mucosa and the proximal third of submucosa; for lesions extending beyond, an oesophagectomy must be discussed. These indications must take into account both age and general condition of the patient, as well as the expertise in oesophageal surgery of the group.