Barrett's oesophagus with high-grade dysplasia (HGD) is now most commonly treated by endoscopic eradication therapy (EET). Which combination represents the current standard endoscopic approach for HGD in Barrett's oesophagus?
- A Oesophagectomy as the only curative option for HGD
- B Endoscopic mucosal resection (EMR) of visible lesions + radiofrequency ablation (RFA) of residual flat Barrett's ✓
- C Argon plasma coagulation (APC) alone for all HGD
- D High-dose proton pump inhibitor therapy for 6 months with repeat biopsy
Explanation
Current UK (BSG) and European guidelines recommend endoscopic eradication therapy (EET) as first-line for Barrett's HGD, consisting of EMR for any visible/nodular lesions (to provide histological staging and exclude T1 carcinoma) followed by RFA for ablation of the remaining flat Barrett's mucosa. RFA using the HALO system achieves complete eradication of intestinal metaplasia in >80% of cases. Oesophagectomy is reserved for early T1b (sm2–3) or deeper carcinoma or endoscopic failure. APC is less effective than RFA and has higher recurrence rates. PPIs alone do not reverse 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.