A 55-year-old man with long-standing Barrett's oesophagus is found to have low-grade dysplasia on two consecutive endoscopies 6 months apart. What is the MOST appropriate management?
- A Endoscopic ablation (radiofrequency ablation) with continued proton pump inhibitor therapy ✓
- B Oesophagectomy — all dysplasia should be resected
- C Surveillance endoscopy every 6 months with biopsy
- D Annual surveillance is adequate; no intervention needed
Correct answer: A. Endoscopic ablation (radiofrequency ablation) with continued proton pump inhibitor therapy
Explanation
Confirmed low-grade dysplasia in Barrett's oesophagus (on two endoscopies by expert pathologists) warrants endoscopic eradication therapy — radiofrequency ablation (RFA) is the gold standard for flat dysplastic Barrett's. RFA reduces progression to high-grade dysplasia and cancer and effectively eradicates dysplastic tissue. Oesophagectomy carries excessive morbidity for LGD. Annual surveillance alone is no longer recommended for confirmed LGD given the progression risk.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.