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Barrett's Oesophagus Surveillance — RACP Adult Medicine MCQ

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HardGastroenterology & HepatologyBarrett's Oesophagus SurveillanceRACP Adult Medicine

A 72-year-old with Barrett oesophagus has a new visible 12-mm mucosal lesion. Targeted biopsy shows high-grade dysplasia without invasive cancer. What is the appropriate next management?

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Correct answer: A — Refer to an expert Barrett service for endoscopic resection of the visible lesion followed by eradication of residual dysplastic Barrett mucosa

The best answer is “Refer to an expert Barrett service for endoscopic resection of the visible lesion followed by eradication of residual dysplastic Barrett mucosa”. A visible dysplastic lesion is first resected endoscopically to stage depth and margins; residual flat dysplastic Barrett mucosa is then eradicated, commonly with ablation. Ablating a visible lesion loses staging tissue, routine long-interval surveillance is unsafe, and oesophagectomy is reserved for disease unsuitable for curative endoscopic therapy or selected invasive cancer.

Reference: Cancer Council Australia: Barrett oesophagus clinical guidelines: https://www.cancer.org.au/health-professionals/clinical-practice-guidelines/barretts-oesophagus