33.A 62-year-old man has had gastroesophageal reflux disease diagnosed by pH monitoring, and present for several years. He has been less than totally compliant with medical management, which he follows when the pain is bad, but discontinues when he feels better. Endoscopy and biopsies show severe peptic esophagitis, with Barrett's esophagus and early dysplastic changes, but no overt carcinoma. Additional tests show good esophageal motility, with low pressure in the lower esophageal sphincter and normal gastric emptying. Which of the following is the most appropriate treatment at this time?
A. Heller myotomy of the lower esophageal sphincter
B. Laparoscopic Nissen fundoplication
C. Transhiatal total esophagectomy
D. Transthoracic resection of the lower esophagus
E. Vagotomy, pyloroplasty, and fundic gastric wrap
___________________ live and let live.
prathapdoctor Forum Elite
Topics: 12 Posts: 406
01/10/07 - 10:53 PM
#2
D.transthoracic resection of the lower esophagus.
Guptashutosh Forum Elite
Topics: 35 Posts: 354
01/11/07 - 06:18 AM
#3
yeah D
anjushree Forum Guru
Topics: 64 Posts: 386
01/16/07 - 01:02 PM
#4
for early dysplastic ----surgery is not required
i will go ----B
prathapdoctor Forum Elite
Topics: 12 Posts: 406
01/16/07 - 01:11 PM
#5
yes,for early dysplastic changes we need not go for surgery but do you think that fundoplication is the treatment for early dysplasia,periodic followup endoscopies are the best mode of treatment for early dysplasia.
robin082006 Forum Hero
Topics: 471 Posts: 5,123
01/16/07 - 01:14 PM
#6
D ___________________ The Key to Succeed is Patience.
webjeee Forum Guru
Topics: 99 Posts: 353
01/16/07 - 04:30 PM
#7
b with followed medication with good compliance
chemamr Forum Hero
Topics: 703 Posts: 4,486
01/16/07 - 05:42 PM
#8
it's like tricky question.
It could be B with endoscopies for monitoring.
what's the answer???
lilla Forum Senior
Topics: 29 Posts: 158
01/23/07 - 10:20 AM
#9
I agree it is B. patients with low-grade dysplasia should undergo repeat endoscopy in 3-6months to see if the lesion has progressed or resolved.
fox Forum Guru
Topics: 70 Posts: 727
01/23/07 - 12:25 PM
#10
B seems to fit best....whatz the answer anyways MD cooper? ___________________ Aim High
drashishmahajan Forum Senior
Topics: 6 Posts: 92
01/23/07 - 12:30 PM
#11
d--- fundoplication is nt the treatmnt for early dysplastic changes .... the patient require local excision procedure like cryo ,,, laser ...since tht option is nt given soooooooooo
Mamay
01/23/07 - 01:42 PM
#12
Well, obviously this Q is not about treatment for early dysplasia - for that the pt needs just follow up... I would give B - fundoplication Edited by Mamay on 01/23/07 - 01:52 PM
sarika Forum Guru
Topics: 195 Posts: 1,200
01/23/07 - 02:00 PM
#13
do B. Laparoscopic Nissen fundoplication now.
Follow up in 3-6 months for low dysplasia
Resection if high dysplasia
fox Forum Guru
Topics: 70 Posts: 727
01/23/07 - 04:48 PM
#14
sarika wrote: do B. Laparoscopic Nissen fundoplication now.
