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git - kallastro
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03-25-2007, 02:52 PM
A 55-year-old man with Barrett™s esophagus undergoes surveillance upper endoscopy. Multiple biopsies are taken, and pathologic examination reveals low-grade dysplasia. What would be appropriate management?
A. Repeat endoscopy in 1 year B. Repeat endoscopy in 3 years C. Repeat endoscopy in 5 years D. Recommend esophagectomy
03-25-2007, 02:55 PM
A. Repeat endoscopy in 1 year
Barrets Only - Every 3 yrs Low Grade - Every 6mo - 1 yr High Grade - Resect then evry 3 mo's
03-25-2007, 02:58 PM
A.
In patients with Barrett™s esophagus, the goal of surveillance is to detect dysplasia and early cancer. According to the American College of Gastroenterology, patients with low-grade dysplasia as the highest grade after a follow-up endoscopy with concentrated biopsies should undergo endoscopy annually until there is no dysplasia. In patients with Barrett™s esophagus who have no dysplasia on 2 endoscopies, the interval may be extended to 3 years. The finding of high-grade dysplasia requires a second endoscopy and confirmation by an experienced pathologist. Patients with focal high-grade dysplasia may be followed with surveillance endoscopies every 3 months; those with confirmed multifocal high-grade dysplasia will likely require esophagectomy. |
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