A 50-year-old man presents with persistent dysphagia. Upper GI endoscopy shows a mid-esophageal mucosal irregularity. Biopsy shows Barrett's esophagus with high-grade dysplasia (HGD) over a 2 cm segment without any visible lesion. The first-line treatment is:

• A Esophagectomy (Ivor-Lewis procedure)
• B High-dose proton pump inhibitor therapy and repeat endoscopy in 3 months
• C Endoscopic submucosal dissection (ESD) of entire Barrett's segment
• D Radiofrequency ablation (RFA) of the dysplastic segment ✓

Explanation

Radiofrequency ablation (RFA) is the first-line endoscopic eradication therapy for Barrett's esophagus with high-grade dysplasia without visible lesions, supported by the AIM Dysplasia trial showing 81% complete eradication of dysplasia and 75% complete eradication of intestinal metaplasia with sustained response. Esophagectomy is now reserved for T1b submucosal invasion or failed endoscopic therapy. When a visible lesion accompanies HGD, endoscopic mucosal resection (EMR) or ESD precedes RFA for complete staging. Acid suppression alone is inadequate for 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.