American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the treatment of choice for patients with Barrett esophagus who have high-grade dysplasia?

1. Surgery

2. Endoscopic ablation

3. Chemotherapy

4. Radiation therapy

The correct answer is: Endoscopic ablation

The treatment of choice for patients with Barrett esophagus who have high-grade dysplasia is endoscopic ablation. This approach is favored because it targets the dysplastic tissue directly and offers a minimally invasive option compared to surgical interventions. Endoscopic ablation techniques, such as radiofrequency ablation or argon plasma coagulation, effectively destroy dysplastic cells while preserving the surrounding healthy tissue. This method not only reduces the risk of progression to esophageal adenocarcinoma but also minimizes morbidity associated with more invasive surgical options. While surgery might be considered in some cases, it is generally reserved for those with invasive cancer or when endoscopic methods fail. Chemotherapy and radiation therapy are not the primary treatments for Barrett esophagus with high-grade dysplasia, as they do not specifically address the dysplastic mucosa and are more suited to systemic malignancies rather than precancerous conditions.