A 55-year-old patient with Barrett's oesophagus on surveillance endoscopy is found to have low-grade dysplasia (LGD) confirmed on two separate endoscopies by two independent pathologists. According to the British Society of Gastroenterology guidelines, what is the recommended management?
- A Immediate oesophagectomy
- B Endoscopic radiofrequency ablation (RFA) ✓
- C 6-monthly surveillance endoscopy without intervention
- D Endoscopic mucosal resection (EMR) of the entire Barrett's segment
Correct answer: B. Endoscopic radiofrequency ablation (RFA)
Explanation
Confirmed low-grade dysplasia in Barrett's oesophagus carries a significant annual progression risk to high-grade dysplasia or cancer (~5-10%/year). Current BSG and NICE guidelines recommend endoscopic radiofrequency ablation (RFA) for confirmed LGD, which achieves durable eradication of dysplasia and reduces cancer risk. Surveillance alone is insufficient given the confirmed dysplasia. EMR is reserved for visible mucosal irregularities or nodularity. Oesophagectomy is reserved for T1b or deeper cancers.
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.