Gastrointestinal surgery: Barrett oesophagus with high-grade dysplasia: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Gastrointestinal surgery: Barrett oesophagus with high-grade dysplasia

Sample item

A 55-year-old man with a 4 cm segment of Barrett oesophagus has biopsies, confirmed by two pathologists, showing high-grade dysplasia in a flat area without any visible nodule. Which management is preferred?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Endoscopic ablation, with mucosal resection of any nodule

High-grade dysplasia in Barrett oesophagus is treated by endoscopic therapy in the modern approach: radiofrequency ablation, with endoscopic mucosal resection for visible lesions to stage them accurately. Oesophagectomy is kept for invasive cancer beyond the mucosa or failure of endoscopic therapy.

Option by option

  • A. Lifelong proton pump inhibitor alone

    Acid suppression does not reverse dysplasia or remove the cancer risk.

  • B. Annual endoscopic surveillance alone

    Surveillance alone leaves a lesion with a high risk of progression to adenocarcinoma untreated.

  • C. Immediate transhiatal oesophagectomy

    Oesophagectomy carries major morbidity and is not required for flat mucosal dysplasia.

  • D. Endoscopic ablation, with mucosal resection of any nodule (correct)

    Correct. Endoscopic eradication removes the dysplastic mucosa while preserving the oesophagus.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is D, Endoscopic ablation, with mucosal resection of any nodule. High-grade dysplasia in Barrett oesophagus is treated by endoscopic therapy in the modern approach: radiofrequency ablation, with endoscopic mucosal resection for visible lesions to stage them accurately.

Why is "Lifelong proton pump inhibitor alone" not the answer?

Acid suppression does not reverse dysplasia or remove the cancer risk.

Why is "Annual endoscopic surveillance alone" not the answer?

Surveillance alone leaves a lesion with a high risk of progression to adenocarcinoma untreated.

Why is "Immediate transhiatal oesophagectomy" not the answer?

Oesophagectomy carries major morbidity and is not required for flat mucosal dysplasia.

What concept does this question test?

It tests Gastrointestinal surgery: Barrett oesophagus with high-grade dysplasia in General Surgery. Oesophagectomy is kept for invasive cancer beyond the mucosa or failure of endoscopic therapy.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastrointestinal surgery: Barrett oesophagus with high-grade dysplasia?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.