A 58-year-old man with Barrett's oesophagus undergoes endoscopic surveillance. Biopsy shows high-grade dysplasia (HGD) without visible lesion. The recommended management per current guidelines is:

• A Oesophagectomy
• B Radiofrequency ablation (RFA) of the Barrett's segment ✓
• C Repeat endoscopy in 3 months to confirm persistence
• D Endoscopic mucosal resection (EMR) of the entire Barrett's segment

Explanation

Current guidelines (BSG, ACG) recommend radiofrequency ablation (RFA) as the first-line endoscopic treatment for flat (non-nodular) high-grade dysplasia in Barrett's oesophagus. RFA ablates the dysplastic columnar epithelium with subsequent re-epithelialisation with squamous mucosa. EMR is preferred for visible nodular lesions (raised HGD or early cancer) to obtain histological staging. Oesophagectomy is reserved for endoscopically unresectable disease.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.