A 55-year-old man with a long history of GORD undergoes surveillance OGD showing circumferential salmon-coloured mucosa from 32 to 38 cm from the incisors. Biopsy shows intestinal metaplasia with specialised columnar epithelium. High-grade dysplasia is found in 2 biopsies. The current recommended treatment for Barrett's oesophagus with high-grade dysplasia is:
- A Endoscopic eradication therapy (endoscopic mucosal resection of visible lesions + radiofrequency ablation of flat segment) ✓
- B Oesophagectomy as high-grade dysplasia has >50% risk of concurrent cancer
- C Proton pump inhibitor therapy with repeat biopsy in 6 months
- D Photodynamic therapy alone
Correct answer: A. Endoscopic eradication therapy (endoscopic mucosal resection of visible lesions + radiofrequency ablation of flat segment)
Explanation
Current guidelines (BSG, ACG) recommend endoscopic eradication therapy (EET) as first-line for Barrett's with high-grade dysplasia: visible lesions are removed by endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for histological staging, followed by radiofrequency ablation (RFA) of the flat dysplastic/metaplastic segment. This achieves complete eradication in >80% of cases with low stricture rates. Oesophagectomy carries significant mortality (2–5%) and is reserved for T1b cancers invading the submucosa or EET failures.
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.