Barrett's oesophagus with low-grade dysplasia on two separate endoscopic biopsies is identified in a 52-year-old man. According to current surveillance guidelines, what is the MOST appropriate management?
- A Endoscopic eradication therapy (radiofrequency ablation) and continued surveillance ✓
- B Oesophagectomy to prevent progression to adenocarcinoma
- C Endoscopic surveillance every 6 months with high-definition endoscopy and quadrantic biopsies
- D High-dose PPI therapy alone with repeat endoscopy in 5 years
Correct answer: A. Endoscopic eradication therapy (radiofrequency ablation) and continued surveillance
Explanation
Current BSG/AGA guidelines recommend endoscopic eradication therapy — specifically radiofrequency ablation (RFA) — for confirmed low-grade dysplasia (LGD) in Barrett's oesophagus, as it reduces progression to high-grade dysplasia and adenocarcinoma. RFA ablates the dysplastic Barrett's segment followed by surveillance endoscopy. Surveillance alone with 6-monthly endoscopy is an alternative acceptable in some guidelines but is inferior to ablation in preventing progression. Oesophagectomy is not indicated for LGD and carries unnecessary morbidity.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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