During an endoscopic examination to evaluate diarrhea in a 63-year-old man, mild Los Angeles Classification System Grade A reflux esophagitis, small hiatal hernia, and a 2-cm segment of Barrett’s esophagus with low- grade dysplasia were diagnosed. He is referred to you for management. He has researched Barrett’s esophagus on the Internet and is very unhappy with the diagnosis of a premalignant disorder. He requests an intervention to pre- vent the progression to cancer. He states that he has not experienced heartburn, acid regur- gitation, dysphagia, and unintentional weight loss. You recommend: 

A 75-year-old male swimmer with a 10-cm segment of Barrett’s esophagus is found at surveillance endoscopy to have a 3-cm area of nodularity at the proximal aspect of the Barrett’s segment. Six biopsy specimens from the nodular region show high-grade dysplasia, as confirmed by two gastrointestinal pathol- ogists. Biopsy specimens from the remaining Barrett’s segment show high-grade dysplasia at the most distal aspect. Otherwise, biopsy specimens show diffuse low-grade dysplasia. He has been taking a PPI for 7 years and is symptomatically well. Chest and abdominal CT scans are without lymphadenopathy. There are no suspicious lesions in the lungs or liver. The results of cardiac stress testing are normal. Both of the patient’s parents lived well into their 90s, and he has always planned to do the same. For treatment, you recommend: 

Because of a family history of Barrett’s esoph- agus, a 67-year-old white man with rare GERD symptoms of 20 years’ duration presents for endoscopy. He states that he does not have dysphagia or unintentional weight loss. At upper endoscopy, he is found to have a 5-cm segment of Barrett’s esophagus, with a 2-cm polypoid nodule present at the proximal aspect of the segment. Biopsy results show adenocarcinoma. He has stable coronary artery disease and hypertension. CT of the chest and abdomen and PET findings are negative for distant metastases. Endoscopic ultrasonography shows the lesion to be T2N0. You recommend: 

A 50-year-old African American woman has rheumatoid arthritis, class IV ischemic car- diomyopathy, and rheumatoid restrictive pul- monary disease requiring nocturnal oxygen supplementation. She informs her rheuma- tologist that her weekly heartburn and rare nocturnal regurgitation of 20 years’ duration have worsened over the past 2 months. She has new nonspecific substernal chest pain with mild odynophagia. She states that she does not have dysphagia, impaction, or uninten- tional weight loss. She is a nonsmoker. She has taken famotidine at bedtime for 10 years. No changes have been found in her cardiac status. Her rheumatologist refers her to you. She has never had EGD. You recommend: 

One month ago, during upper endoscopy performed to investigate iron deficiency anemia, Barrett’s esophagus of unknown length was diagnosed in a 35-year-old woman who did not have heartburn, acid regurgitation, dysphagia, or upper respira- tory tract symptoms. She has been referred to you for management. The slides have been reviewed by your pathologist, who confirms the presence of intestinal meta- plasia with goblet cells, without dysplasia. You recommend: