A 45-year-old woman with long-segment Barrett's esophagus (8 cm) develops high-grade dysplasia confirmed by two expert pathologists. What is the current recommended management per BSG/AGA guidelines?
- A Esophagectomy as the gold standard treatment
- B Continue high-dose PPI and surveillance every 3 months
- C Photodynamic therapy as first-line ablation
- D Radiofrequency ablation (RFA) after endoscopic mucosal resection of any visible lesions ✓
Explanation
Current BSG/AGA/ESGE guidelines recommend endoscopic eradication therapy (EET) for high-grade dysplasia in Barrett's esophagus. The approach involves endoscopic mucosal resection (EMR) of any visible or nodular areas (for histological staging) followed by radiofrequency ablation (RFA) of the remaining flat Barrett's segment. This achieves complete eradication of dysplasia in >90% and complete eradication of intestinal metaplasia in >80% of cases, with durable results and preservation of the esophagus. Esophagectomy carries significant morbidity (3–5% mortality) and is no longer the first-line for HGD without submucosal invasion. PDT has been superseded by RFA. Surveillance alone is inappropriate for confirmed HGD.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.