50-pack-year Smoking History Has in Surgery — 66yo Man | General Surgery | SMLE Q#11353
SMLE Question #11353
Surgery
General Surgery
Objective: OBJ-TRACH-EMERG-01
Last updated: February 2026
A 66-year-old man with a 50-pack-year smoking history has 1 year of retrosternal burning and sour regurgitation, worse after meals and when lying flat. Symptoms partially improve with over-the-counter antacids but recur daily. He has no weight loss, dysphagia, or odynophagia. Upper endoscopy shows a short segment of distal esophageal mucosal irregularity. Targeted biopsies show intestinal metaplasia with high-grade dysplasia and no invasive carcinoma. What is the most appropriate next step in management?
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