A 55-year-old man with Barrett's esophagus undergoes endoscopic surveillance. Biopsy confirms high-grade dysplasia (HGD) with no visible lesion and no endoscopic evidence of adenocarcinoma. What is the most appropriate management according to current guidelines?
- A Repeat endoscopy in 3 months for surveillance
- B Endoscopic eradication therapy (radiofrequency ablation ± endoscopic mucosal resection) ✓
- C Esophagectomy
- D High-dose PPI therapy and repeat biopsy in 6 months
Explanation
Endoscopic eradication therapy (EET) is the first-line treatment for Barrett's esophagus with high-grade dysplasia or intramucosal adenocarcinoma (T1a disease). Radiofrequency ablation (RFA) achieves eradication of dysplastic Barrett's in approximately 80-90% of patients. For any visible mucosal abnormality, endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) should precede ablation to obtain staging histology. Esophagectomy is reserved for HGD/T1a disease where endoscopic therapy fails or is not feasible, and is standard for T1b disease with submucosal invasion due to significant lymph node metastasis 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.