The correct answer is:
C) Repeat upper endoscopy in 3–5 years
This patient has nondysplastic Barrett esophagus, a condition in which chronic gastroesophageal reflux results in replacement of the normal stratified squamous epithelium of the distal esophagus with specialized intestinal-type columnar epithelium. Barrett esophagus is important because it is the primary precursor lesion for esophageal adenocarcinoma.
The key management question is risk stratification. Patients with Barrett esophagus without dysplasia have a relatively low annual risk of progression to adenocarcinoma. Therefore, aggressive interventions such as endoscopic ablation or surgery are not routinely indicated. Instead, periodic surveillance endoscopy is recommended to identify progression to dysplasia before invasive cancer develops. Current surveillance intervals for nondysplastic Barrett esophagus are generally every 3–5 years.
Step 2 frequently tests the progression sequence:
GERD → Barrett esophagus → low-grade dysplasia → high-grade dysplasia → esophageal adenocarcinoma
The management changes as dysplasia develops. Nondysplastic Barrett esophagus is managed with proton pump inhibitor therapy and surveillance. High-grade dysplasia generally warrants endoscopic eradication therapy because the risk of progression to cancer becomes substantial.
A common board pitfall is assuming that all premalignant lesions require immediate removal. In Barrett esophagus, the degree of dysplasia determines management intensity.
Answer choice A: Endoscopic eradication therapy immediately, is incorrect.
Endoscopic eradication therapy is commonly used for high-grade dysplasia and selected cases of low-grade dysplasia. This patient has no dysplasia and therefore does not require immediate ablation.
Answer choice B: No further surveillance is necessary, is incorrect.
Although the absolute cancer risk is relatively low, Barrett esophagus remains a premalignant condition. Surveillance is recommended to detect progression to dysplasia.
Answer choice D: Repeat upper endoscopy in 10 years, is incorrect.
This interval is excessively long and may delay detection of dysplastic progression.
Answer choice E: Surgical esophagectomy, is incorrect.
Esophagectomy is reserved for selected patients with advanced neoplasia or invasive cancer and is not appropriate for uncomplicated nondysplastic Barrett esophagus.
Key Learning Point
Patients with nondysplastic Barrett esophagus should undergo surveillance upper endoscopy every 3–5 years because Barrett esophagus is a precursor lesion for esophageal adenocarcinoma.
