Phys Vivas · gastrointestinal
Oesophageal Disorders — Viva Defence
Structured DCE viva for oesophageal disorders: long-case defence of a 70-year-old with Barrett's oesophagus and confirmed low-grade dysplasia against a background of cardiac comorbidity — the ablate-versus-survey decision.
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Opening statement (SASPOP, delivered aloud)
"Mr Atherton is a 70-year-old retired headmaster with long-segment Barrett's oesophagus that has progressed to confirmed low-grade dysplasia on surveillance, on a background of ischaemic cardiomyopathy, chronic kidney disease and anticoagulated atrial fibrillation. His main problems are: a premalignant oesophageal condition that has crossed the threshold where guidelines recommend endoscopic eradication rather than continued surveillance; procedural risk shaped by his cardiac function and anticoagulation; and the question of what he personally wants from treatment at this stage of his life. I would like to confirm the dysplasia, stage the segment properly, and then make an individualised decision with him about endoscopic eradication versus continued surveillance." [1]
References5ShowHide
- [1]Shaheen NJ, Falk GW, Iyer PG, et al. Diagnosis and Management of Barrett's Esophagus: An Updated ACG Guideline Am J Gastroenterol, 2022.PMID 35354777
- [2]Phoa KN, van Vilsteren FG, Weusten BL, et al. Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia: a randomized clinical trial JAMA, 2014.PMID 24668102
- [3]Shaheen NJ, Sharma P, Overholt BF, et al. Radiofrequency ablation in Barrett's esophagus with dysplasia N Engl J Med, 2009.PMID 19474425
- [4]Hvid-Jensen F, Pedersen L, Drewes AM, et al. Incidence of adenocarcinoma among patients with Barrett's esophagus N Engl J Med, 2011.PMID 21995385
- [5]Sharma P, Dent J, Armstrong D, et al. The development and validation of an endoscopic grading system for Barrett's esophagus: the Prague C & M criteria Gastroenterology, 2006.PMID 17101315