American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the preferred treatment modality for patients with confirmed Barrett esophagus and low-grade dysplasia?

1. Endoscopic ablative therapy

2. Surgical resection

3. Radiofrequency ablation

4. Medical management with proton pump inhibitors

The correct answer is: Endoscopic ablative therapy

For patients with confirmed Barrett esophagus and low-grade dysplasia, endoscopic ablative therapy is often preferred due to its effectiveness in reducing the risk of progression to high-grade dysplasia and esophageal adenocarcinoma. This modality can involve techniques such as endoscopic radiofrequency ablation or photodynamic therapy, which selectively target abnormal cells while preserving healthy tissue. The rationale for selecting endoscopic ablative therapy lies in its minimally invasive nature and its ability to effectively eliminate dysplastic cells in the esophagus. This approach is supported by clinical guidelines that suggest active intervention when low-grade dysplasia is confirmed, as it can significantly reduce the risk of potential complications associated with untreated Barrett esophagus. Other options, while relevant in different contexts, do not align as closely with current management protocols for this specific patient scenario. Surgical resection is more invasive and typically reserved for cases with higher stages of dysplasia or when there is unequivocal evidence of cancer. Medical management with proton pump inhibitors, while important for managing acid reflux symptoms, does not address the dysplastic changes in the esophagus. Therefore, endoscopic ablative therapy stands out as the preferred approach for managing Barrett esophagus with low-grade dysplasia.