Barrett's esophagus with low-grade dysplasia confirmed by two expert pathologists: the most appropriate initial management according to British Society of Gastroenterology guidelines is:
- A Endoscopic mucosal resection of visible lesions and endoscopic eradication therapy (radiofrequency ablation) ✓
- B Oesophagectomy to prevent progression to invasive cancer
- C High-dose proton pump inhibitor therapy alone with 3-monthly endoscopic surveillance
- D Photodynamic therapy as first-line eradication
Correct answer: A. Endoscopic mucosal resection of visible lesions and endoscopic eradication therapy (radiofrequency ablation)
Explanation
Confirmed low-grade dysplasia in Barrett's esophagus carries a significant risk of progression to high-grade dysplasia or adenocarcinoma (approximately 9% per year for high-grade). BSG guidelines recommend endoscopic eradication therapy — typically radiofrequency ablation (RFA) — with endoscopic mucosal resection of any visible lesion first. RFA achieves eradication of dysplasia in 80–90% of patients. Oesophagectomy is only indicated for invasive cancer not amenable to endoscopic treatment. Surveillance alone is inadequate for confirmed LGD.
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.