A 58-year-old man with a long history of GERD undergoes endoscopy showing circumferential salmon-pink mucosa extending 4 cm above the GOJ with goblet cells on biopsy. This confirms Barrett's oesophagus. The MOST important histological feature that upgrades surveillance intensity and mandates intervention is:
- A High-grade dysplasia (HGD) or intramucosal carcinoma ✓
- B Non-dysplastic Barrett's oesophagus
- C Intestinal metaplasia without dysplasia
- D Low-grade dysplasia (LGD) confirmed by two expert pathologists
Correct answer: A. High-grade dysplasia (HGD) or intramucosal carcinoma
Explanation
High-grade dysplasia (HGD) or intramucosal adenocarcinoma (T1a) in Barrett's oesophagus requires endoscopic eradication therapy — typically endoscopic mucosal resection (EMR) for visible lesions followed by radiofrequency ablation (RFA) of residual flat Barrett's. LGD is managed with increased surveillance (6-monthly) or ablation in confirmed cases. Non-dysplastic Barrett's requires 3–5 yearly surveillance only. HGD has ~30% risk of synchronous invasive carcinoma and ~13% annual progression 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.