Barrett Esophagus

Offer a single screening endoscopy to patients with chronic GERD symptoms who also have 3 or more additional Barrett esophagus risk factors: male sex, age greater than 50 years, White race, tobacco smoking, obesity, or a first-degree family history of Barrett esophagus or esophageal adenocarcinoma. PubMedPubMedDiagnosis and Management of Barrett’s Esophagus: An Updated ACG Guideline - PMC

Do not place patients with an irregular Z-line or columnar-lined esophagus shorter than 1 cm into a Barrett surveillance program. AGA guidance conditionally recommends against surveillance for columnar-lined esophagus shorter than 1 cm, and NICE recommends no surveillance for confirmed short-segment Barrett esophagus under 3 cm without intestinal metaplasia after 2 endoscopies. ScienceDirect+1ScienceDirectAntireflux Surgery Versus Antireflux Medication and Risk of Esophageal Adenocarcinoma in Patients With Barrett’s Esophagusnice org ukRecommendations | Barrett's oesophagus and stage 1 oesophageal adenocarcinoma: monitoring and management | Guidance | NICE

During diagnostic endoscopy, document Barrett extent with the Prague C&M classification and obtain at least 8 biopsies when endoscopic findings suggest Barrett esophagus; use the Seattle protocol for segments longer than 4 cm. PubMedPubMedDiagnosis and Management of Barrett’s Esophagus: An Updated ACG Guideline - PMC

Use high-resolution white-light endoscopy plus chromoendoscopy, including virtual chromoendoscopy, for Barrett surveillance. Perform targeted biopsies from visible lesions, then systematic 4-quadrant biopsies every 2 cm in patients without prior dysplasia and every 1 cm when there is a history of dysplasia. Gastroenterology+1GastroenterologyAGA Clinical Practice Guideline on Surveillance of Barrett's ...PubMedDiagnosis and Management of Barrett’s Esophagus: An Updated ACG Guideline - PMC

The Seattle protocol consists of careful inspection, biopsy of visible lesions, and 4-quadrant biopsies at intervals no greater than 2 cm from the lower esophageal sphincter to the squamocolumnar junction. Its purpose is to reduce sampling error because dysplasia can be focal and endoscopically inconspicuous. PubMedPubMedDiagnosis and Management of Barrett’s Esophagus: An Updated ACG Guideline - PMC

Before labeling a patient low-grade dysplasia, high-grade dysplasia, or indefinite for dysplasia, obtain confirmation from a second pathologist with gastrointestinal pathology expertise. This is a strong ACG recommendation for dysplasia of any grade and is particularly consequential because the diagnosis determines whether the patient enters ablation therapy. PubMedPubMedDiagnosis and Management of Barrett’s Esophagus: An Updated ACG Guideline - PMC

For nondysplastic Barrett esophagus, use endoscopic surveillance rather than routine endoscopic eradication therapy. RFA is not suggested for the general population without dysplasia because comparative evidence has not established a superior net health outcome over surveillance. Wolters Kluwer+1Wolters KluwerEndoscopic eradication therapy for Barrett's... : Current Opinion in ...nice org uk[PDF] NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE

For confirmed low-grade dysplasia, discuss endoscopic eradication therapy versus surveillance, but favor RFA when dysplasia is confirmed on biopsies from 2 separate endoscopies and by 2 gastrointestinal pathologists. Randomized evidence shows RFA improves complete eradication of dysplasia and intestinal metaplasia compared with surveillance and shows benefit for progression to high-grade dysplasia or cancer, although progression estimates are imprecise. BMJ+2BMJNational Institute for Health and Care Excellence (NICE) guidance on monitoring and management of Barrett’s oesophagus and stage I oesophageal adenocarcinoma | Gutnice org ukRecommendations | Barrett's oesophagus and stage 1 oesophageal adenocarcinoma: monitoring and management | Guidance | NICEnice org uk[PDF] Barrett's oesophagus and stage 1 oesophageal adenocarcinoma

For high-grade dysplasia, proceed with endoscopic eradication therapy rather than surveillance as first-line management. If a visible lesion is present, perform endoscopic resection, typically EMR, for staging and therapy, then ablate residual Barrett mucosa. NICE specifically recommends ablation of residual Barrett esophagus after endoscopic resection for high-grade dysplasia. Nature+1NatureUtility of ancillary studies in the diagnosis and risk assessment of Barrett’s esophagus and dysplasia | Modern Pathologynice org ukRecommendations | Barrett's oesophagus and stage 1 oesophageal adenocarcinoma: monitoring and management | Guidance | NICE

Arrange endoscopic follow-up after endoscopic treatment for Barrett esophagus with dysplasia. During post-eradication examinations, inspect the esophagus and cardia using white light, virtual chromoendoscopy, and near focus to identify recurrent Barrett mucosa or neoplasia. Gastroenterology+1GastroenterologyAGA Clinical Practice Guideline on Endoscopic Eradication Therapy ...nice org ukRecommendations | Barrett's oesophagus and stage 1 oesophageal adenocarcinoma: monitoring and management | Guidance | NICE

Continue long-term follow-up after apparent complete eradication because progression or recurrence can occur after endoscopic eradication therapy. nice org uknice org uk[PDF] NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE

Do not recommend fundoplication or other antireflux surgery solely to prevent esophageal adenocarcinoma in Barrett esophagus. In a cohort of 33,939 patients followed for up to 32 years, antireflux surgery was not associated with reduced adenocarcinoma risk versus antireflux medication (adjusted hazard ratio 1.9; 95% CI, 1.1-3.5). ScienceDirect+1ScienceDirectAntireflux Surgery Versus Antireflux Medication and Risk of Esophageal Adenocarcinoma in Patients With Barrett’s EsophagusPubMedAntireflux Surgery Versus Antireflux Medication and Risk of Esophageal Adenocarcinoma in Patients With Barrett's Esophagus - PubMed