Barrett's oesophagus with low-grade dysplasia (LGD) confirmed by two expert pathologists is best managed according to current BSG/ESGE guidelines by:
- A Oesophagectomy to prevent progression to high-grade dysplasia and adenocarcinoma
- B High-dose PPI therapy alone with endoscopic surveillance every 6 months
- C Radiofrequency ablation (RFA) as the preferred endoscopic eradication therapy, shown to reduce progression to HGD/cancer ✓
- D Annual endoscopic surveillance with four-quadrant biopsies every 2 cm without intervention
Correct answer: C. Radiofrequency ablation (RFA) as the preferred endoscopic eradication therapy, shown to reduce progression to HGD/cancer
Explanation
Current guidelines (BSG 2014, ESGE 2017) recommend radiofrequency ablation for confirmed LGD in Barrett's oesophagus. The UK RFA trial demonstrated that RFA significantly reduced progression to HGD (1.2% vs. 8.8% annualised rate) and adenocarcinoma compared to surveillance. RFA eradicates dysplastic mucosa without the risks of oesophagectomy. After RFA, patients require surveillance with biopsies. PPI therapy alone is insufficient management for confirmed LGD, and annual surveillance without treatment accepts an unnecessary progression risk.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.