Even if one could confidently exclude invasive cancer when high-grade dysplasia is identified, the risk of subsequent progression to cancer is high. Prospective series reveal that 32 (28%) of 115 patients with high-grade dysplasia went on to develop adenocarcinoma over a period of up to 9.5 years. These data, which support esophagectomy for such patients, have been tempered by recent evidence that a significant proportion of these patients may have regression of the high-grade dysplasia over time. In one study, 27% of patients had lesser grades of dysplasia or no dysplasia on subsequent follow-up.30 Also, even expert centers continue to report operative mortality rates of 3% to 6% and morbidity rates as high as 40% for esophagectomy.34,35 Therefore, some experts advise continued surveillance for individuals with high-grade dysplasia and reserve esophagectomy only for those who develop adenocarcinoma. They argue that, with close surveillance at 3- to 6-month intervals, if cancer is detected, esophagectomy will be curative in most patients. Further, the morbidity and mortality of esophagectomy will be avoided in those whose high-grade dysplasia might regress or remain unchanged.