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Management of Low-Grade Dysplasia in Barrett's

A 56-year-old man with Barrett's oesophagus and persistent low-grade dysplasia after high-dose proton pump inhibitor therapy is evaluated for the next step in management. The recommended approach is radiofrequency ablation, as studies indicate it significantly reduces the risk of progression to high-grade dysplasia or cancer compared to continuing proton pump inhibitors. Other options like oesophagectomy and photodynamic therapy are deemed less appropriate for low-grade dysplasia.

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6 views1 page

Management of Low-Grade Dysplasia in Barrett's

A 56-year-old man with Barrett's oesophagus and persistent low-grade dysplasia after high-dose proton pump inhibitor therapy is evaluated for the next step in management. The recommended approach is radiofrequency ablation, as studies indicate it significantly reduces the risk of progression to high-grade dysplasia or cancer compared to continuing proton pump inhibitors. Other options like oesophagectomy and photodynamic therapy are deemed less appropriate for low-grade dysplasia.

Uploaded by

nomanaslam3003
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Question 76 of 100 LOG OUT 

0:42:20/03:00:00

A 56-year-old man who has been diagnosed with Barrett’s oesophagus returns to his General Practitioner six Difficulty: Average
months after commencing high-dose proton pump inhibitor therapy and a surveillance endoscopy. His biopsy
shows persistent areas of low-grade dysplasia. Peer Responses %
What is the most appropriate next step?

Your answer was correct

A Add domperidone

B Continue high-dose proton pump inhibitor

C Oesophagectomy Q. Answered Flagged

Q1
D Photodynamic therapy
Q2
E Radiofrequency ablation
Q3

Q4
Explanation 
Q5

E Radiofrequency ablation
Q6

Studies have shown that low-grade dysplasia is still associated with relatively high rates of progression to Q7
either high-grade dysplasia or oesophageal cancer, even when patients are treated with high-dose proton
pump inhibitors. Over three years, 26.5% of patients who continued on high-dose proton pump inhibitors only Q8
progressed to high-grade dysplasia or cancer, compared to 1% when they were treated with radiofrequency
Q9 
ablation. This has driven radiofrequency ablation to be recommended by the British Society of
Gastroenterology.

 External Links
A Add domperidone
BSG guidelines on the diagnosis an…
[Link]/clinical-resource/bsg-guidelin…
Unfortunately, adding a prokinetic antiemetic does not reduce mortality from cancer in Barrett’s oesophagus. It
is not of value here.

B Continue high-dose proton pump inhibitor

This is inappropriate because data suggest that progression to high-grade dysplasia or oesophageal cancer is
approximately 27% over three years.

C Oesophagectomy

Oesophagectomy is only recommended for high-grade dysplasia of the oesophageal mucosa. Low-grade
dysplasia is managed with radiofrequency ablation in the first instance.

D Photodynamic therapy

Photodynamic therapy is thought to be less effective than radiofrequency ablation in treating Barrett’s
oesophagus.
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