A 55-year-old man with biopsy-proven Barrett's esophagus with high-grade dysplasia (HGD) is evaluated. He is fit for endoscopy. According to ACG and BSG 2022 guidelines, the preferred treatment is:
- A Esophagectomy — only definitive treatment for HGD
- B High-dose proton pump inhibitor therapy with repeat biopsy in 3 months
- C Radiofrequency ablation (RFA) of flat HGD with endoscopic mucosal resection (EMR) of visible lesions ✓
- D Photodynamic therapy as first-line ablative treatment
Explanation
Current ACG and BSG guidelines recommend endoscopic eradication therapy (EET) for Barrett's esophagus with HGD. The approach is: EMR or ESD for any visible mucosal irregularities (nodularity, raised lesions) to provide staging histology and curative intent for T1a lesions, followed by radiofrequency ablation (RFA) for flat Barrett's mucosa. This combined approach achieves eradication of intestinal metaplasia in 80-90% of cases. Esophagectomy is reserved for submucosal invasion (T1b with deep SM2/SM3 invasion) or failed endoscopic therapy. PPI therapy alone does not reverse HGD. PDT has been superseded by RFA due to better side-effect profile and equivalent efficacy.
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.