A 58-year-old man with a long history of GORD undergoes endoscopy showing 6 cm circumferential salmon-pink mucosa replacing the squamo-columnar junction, confirmed as specialised intestinal metaplasia with high-grade dysplasia (HGD) on biopsy. According to current ACG/BSG guidelines, the preferred management for Barrett's oesophagus with HGD is:
- A Oesophagectomy as HGD has 50% concurrent adenocarcinoma risk
- B Intensive endoscopic surveillance every 3 months with biopsy protocol
- C Endoscopic eradication therapy (endoscopic mucosal resection of visible lesions + radiofrequency ablation of flat HGD) ✓
- D Proton pump inhibitor dose escalation and repeat endoscopy in 6 months
Explanation
Current BSG and ACG guidelines recommend endoscopic eradication therapy (EET) as the preferred management for Barrett's oesophagus with HGD. This comprises endoscopic mucosal resection (EMR) of any visible mucosal abnormalities/nodules for staging and treatment, followed by radiofrequency ablation (RFA) of flat HGD segments to prevent progression. Complete eradication of dysplasia and intestinal metaplasia is achievable in >80% of cases. Oesophagectomy is now reserved for confirmed intramucosal adenocarcinoma with submucosal invasion (T1b) or EMR/RFA failure. Surveillance alone for HGD is inadequate given high 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.