The management of Barrett's esophagus with high-grade dysplasia is controversial. The standard of care hastraditionally been esophagectomy. However, a number oftreatment options aimed at esophageal preservation areincreasingly being utilized by many centers.
Histological evaluation of high-grade dysplasiashould be undertaken by two pathologists expe-rienced in interpreting esophageal metaplasiaand dysplasia. （Level C Evidence）Class IIa
It is reasonable to limit endoscopic surveillance ofhigh-grade dysplasia to high-volume centers withspecific expertise in the management of Barrett'sesophagus and preferably performed in the con-text of a clinical trial. （Level B Evidence）Class IIb
Surveillance may be considered for patients withflat, unifocal high-grade-dysplasia as they are atlower risk for progression to cancer compared topatients with multifocal HGD or those with dyspla-sia-associated lesions or masses. （Level B Evidence）