A 55-year-old man with Barrett's esophagus undergoes surveillance endoscopy. Biopsies show high-grade dysplasia (HGD). According to current BSG/ACG guidelines, the preferred management is:

• A Oesophagectomy
• B Intensive 3-monthly surveillance with proton pump inhibitor therapy
• C Photodynamic therapy alone
• D Endoscopic eradication therapy (EET): endoscopic mucosal resection (EMR) of visible lesions + radiofrequency ablation (RFA) of remaining Barrett's ✓

Explanation

Current guidelines (BSG 2023, ACG 2022) recommend endoscopic eradication therapy as first-line for Barrett's esophagus with high-grade dysplasia. EMR/ESD is used for visible nodular lesions (to provide histology and staging), followed by RFA of the remaining flat Barrett's mucosa to eradicate dysplastic and metaplastic epithelium. EET achieves >90% complete eradication of dysplasia and Barrett's mucosa. Oesophagectomy is now reserved for T1b (submucosal) or deeper lesions not amenable to endoscopic therapy. 3-monthly surveillance is inappropriate for HGD.

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.