Barrett's Oesophagus — RACP Adult Medicine MCQ

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HardGastroenterology & HepatologyBarrett's OesophagusRACP Adult Medicine

A 60-year-old man with known Barrett's oesophagus with low-grade dysplasia undergoes surveillance endoscopy. Biopsies now show high-grade dysplasia without visible nodularity. What is the most appropriate management?

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Correct answer: A — Endoscopic radiofrequency ablation (RFA)

Confirmed high-grade dysplasia in Barrett's oesophagus is an indication for endoscopic eradication therapy, with radiofrequency ablation (RFA) being the preferred modality. RFA eliminates dysplastic Barrett's epithelium with high efficacy (~90% complete eradication). EMR is used for visible nodules/lesions. Oesophagectomy is reserved for intramucosal carcinoma not amenable to endoscopic therapy or for multifocal disease.

Reference: Cancer Council Australia – 2020 – Barrett's Oesophagus Guidelines; BSG – 2024 – Barrett's Guidelines