A patient with Barrett's oesophagus undergoes endoscopic surveillance. Biopsies from a flat segment reveal high-grade dysplasia (HGD) without a visible lesion. According to current BSG/ESGE guidelines, what is the most appropriate management?
- A Endoscopic radiofrequency ablation (RFA) after staging endoscopy confirms absence of nodularity ✓
- B Oesophagectomy for all cases of HGD in Barrett's
- C Increased surveillance endoscopy every 3 months without treatment
- D High-dose PPI therapy and repeat biopsy in 6 months
Explanation
Current ESGE and BSG guidelines recommend endoscopic radiofrequency ablation (RFA) as the treatment of choice for flat (non-nodular) HGD in Barrett's oesophagus, as it achieves complete eradication of dysplasia in >90% of patients with a favourable safety profile. Before RFA, a careful endoscopic assessment (ideally with advanced imaging) is required to rule out any mucosal irregularity; if present, endoscopic mucosal resection (EMR) of the visible lesion is performed first. Oesophagectomy is no longer recommended as first-line for HGD due to significant operative morbidity and mortality. Surveillance alone is inappropriate for confirmed HGD.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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