Q1) achalasia is...Progressive disease according to Premier review
.......................Non progressive according to MTB??
Q2)what is the follow up of endoscopy??
According to Premier:
Barrets esophagus...endoscopy 3-5 yrs with biopsy
low grade dysplasis...endoscopy every year with biopsy
high grade................surgery
According to MTB:
barrets ....2-3 yrs with biopsy
low grade....3-6 months with biopsy
high grade...surgey
guys...which book is more authentic??
From CMDT 2010.
In patients known to have Barrett esophagus, surveillance endoscopy" every 3 years" to look for dysplasia or adenocarcinoma generally is recommended.
Patients with low-grade dysplasia require repeat endoscopic surveillance in" 6 months" to screen for coexisting high-grade dysplasia or cancer.
If low-grade dysplasia "PERSISTS" (which occurs in < 25% of patients), endoscopic surveillance should be repeated "yearly."
Photodynamic therapy or radiofrequency wave electrocautery (HALO) may be used to ablate Barrett tissue in patients with "high-grade dysplasia without a visible esophageal nodule" and to ablate Barrett tissue after endoscopic mucosal resection of a nodule with high-grade dysplasia or intramucosal cancer. An uncontrolled prospective US endoscopic study of radiofrequency wave ablation of Barrett tissue with high-grade dysplasia has shown complete resolution of dysplasia in 80% of patients.
Alternatively, patients with "high-grade dysplasia without visible lesions" may undergo close endoscopic surveillance with biopsy every 3“6 months, reserving surgery or photodynamic therapies for approximately 7% of patients per year during follow-up in whom adenocarcinoma develops
So, the treatment of patients with high-grade dysplasia or superficial mucosal cancers is controversial and evolving rapidly..
Until recently, esophagectomy has been recommended for all patients deemed to have a low operative risk. However, esophagectomy is associated with high morbidity and mortality rates (40% and 2“9%, respectively). Therefore, other options should be considered for patients with high-grade dysplasia, especially those who are deemed to be at high risk for esophagectomy.
try to use reference book if have confusion.
look arround to download CMDT 2010