A 58-year-old man with a 10-year history of GERD undergoes surveillance upper endoscopy. Biopsy shows high-grade dysplasia (HGD) in Barrett's oesophagus (segment length 5 cm). CT chest/abdomen is negative for invasion or nodes. What is the current recommended management?
- A Endoscopic mucosal resection (EMR) or radiofrequency ablation (RFA) for the dysplastic segment ✓
- B Oesophagectomy (Ivor Lewis procedure)
- C Intensive PPI therapy and repeat biopsy in 6 months
- D Photodynamic therapy as sole treatment
Correct answer: A. Endoscopic mucosal resection (EMR) or radiofrequency ablation (RFA) for the dysplastic segment
Explanation
High-grade dysplasia in Barrett's oesophagus without evidence of submucosal invasion on endoscopic resection specimens is optimally managed by endoscopic therapy — endoscopic mucosal resection (EMR) for visible lesions plus radiofrequency ablation (RFA) for the remaining flat dysplastic mucosa. This achieves complete eradication with cure rates equivalent to oesophagectomy but with far lower morbidity. Oesophagectomy is reserved for T1b (submucosal) or higher disease.
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.