After this activity, the participant will be able to recognize the importance of endoscopic surveillance after successful endoscopic eradication therapy for Barrett's esophagus with low-grade dysplasia, high-grade dysplasia, or intramucosal cancer. In addition, the participant will be able to evaluate the benefits of endoscopic surveillance compared with the risks of endoscopy in patients after endoscopic eradication therapy.
A 58-year-old man presents to your clinic to establish care as a new patient. He has a history of Barrett's esophagus with high-grade dysplasia and T1a esophageal adenocarcinoma. Approximately 1 ½ years ago, the patient underwent endoscopic mucosal resection followed by 3 radiofrequency ablation sessions. His last esophagogastroduodenoscopy with biopsies 3 months ago showed no evidence of intestinal metaplasia, dysplasia, or malignancy, consistent with complete eradication of intestinal metaplasia. He has a history of hypertension and a 3-cm hiatal hernia. His body mass index is 38 kg/m2. The patient is currently taking a proton pump inhibitor twice daily with good control of his reflux symptoms.
What is the best next step in the care of this patient?
- A. Increase the dose of the proton pump inhibitor
- B. Anti-reflux surgery
- C. Repeat endoscopy for surveillance
- D. Weight loss management
An 85-year-old man presents to your clinic for routine follow up. The patient has a history of long-segment Barrett's esophagus with low-grade dysplasia that was successfully treated with radiofrequency ablation 5 years ago. His last esophagogastroduodenoscopy 2 years ago demonstrated no evidence of intestinal metaplasia or dysplasia. The patient has a longstanding history of atrial fibrillation and suffered a stroke 6 months ago. His medical history also includes diabetes mellitus, hypertension, coronary artery disease, and chronic kidney disease. He is on chronic anticoagulation.
What is the best next step in the management of this patient?
- A. Upper GI series
- B. Stop endoscopic surveillance
- C. Continue endoscopic surveillance
- D. Computer tomography of the chest and abdomen
In this study, what was the most likely indication for retreatment after successful endoscopic eradication therapy for Barrett's esophagus with low-grade dysplasia (LGD)?
- A. Intestinal metaplasia with no evidence of dysplasia
- B. Intestinal metaplasia with LGD
- C. Intestinal metaplasia with high-grade dysplasia (HGD)
- D. Intestinal metaplasia with HGD and intramucosal adenocarcinoma