A 50-year-old man with Barrett's oesophagus undergoes endoscopic surveillance. Biopsy shows high-grade dysplasia (HGD) in a 2 cm segment. Which ablative modality has the highest efficacy and is the current preferred treatment?

• A Oesophagectomy
• B Endoscopic mucosal resection (EMR)
• C Radiofrequency ablation (RFA) ✓
• D Photodynamic therapy (PDT)

Explanation

Radiofrequency ablation (RFA) achieves complete eradication of HGD in >90% and intestinal metaplasia in >80% of cases, with low stricture and perforation rates. It is the current standard endoscopic ablative treatment for flat HGD in Barrett's oesophagus per BSG and ACG guidelines. EMR is preferred for nodular/raised lesions for histological staging, often combined with RFA for the flat segment. Oesophagectomy is reserved for failure of endoscopic therapy.

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.