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Guidelines for Surveillance of Barrett’s Esophagus

One of our blog visitors had a question about how often endoscopy should be performed in patients with Barrett’s esophagus.

With Barrett’s esophagus, studies have shown that surveillance endoscopy (EGD) for dysplasia improves survival by detecting small esophageal cancers earlier in their course. Because of this, several national gastroenterology societies have published guidelines for the surveillance of Barrett’s esophagus. Most recently, the American College of Gastroenterology updated their Barrett’s esophagus guidelines. The guidelines were created using the available published research on BE and dysplasia about the risk of progression to cancer and surveillance of BE.

Here are the 2008 ACG BE Surveillance Guidelines:

For BE with no dysplasia

  • a second EGD with biopsies within a year to confirm there is no dysplasia
  • If both EGDs with biopsies show no dysplasia, then repeat EGD with biopsy is recommended every 3 years

For BE with low grade dysplasia (LGD)

  • Have the pathology slides showing LGD read by an expert pathologist (to make sure no high grade dysplasia (HGD) is present
  • Repeat EGD with biopsies within 6 months to reassess for dysplasia
  • If no dysplasia is present on repeat EGD, then yearly EGD with biopsy is recommended until two years worth of EGDs show no dysplasia

For BE with high grade dysplasia (HGD)

  • Have the pathology slides showing HGD read by an expert pathologist to confirm the diagnosis
  • If the HGD is found in a mucosal irregularity (i.e. and ulcer, a nodule, a bumpy area of the esophagus), then endoscopic mucosal resection (EMR) is recommended to remove it
  • EGD with biopsies should be repeated within 3 months to look for HGD and tiny cancers. Intervention should be performed based on the biopsy results and tailored to the patient.
  • Possible interventions for HGD include – esophagectomy, endoscopic mucosal resection, photodynamic therapy, radiofrequency ablation, ablation using cryotherapy

These are the newest guidelines and they’re widely used, but some gastroenterologists do screen more frequently, so talk with your gastroenterologist to see what he/she recommends.

The reference for the ACG Guidelines is:

Wang, KK and Sampliner, RE. Updated guidelines 2008 for the diagnosis, surveillance, and therapy of Barrett’s esophagus. American Journal of Gastroenterology 2008, volume 103, pages 788-797.

posted by Kerry Dunbar, MD

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This entry was posted on Thursday, October 30th, 2008 at 7:49 am and is filed under basics. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

5 Responses to “Guidelines for Surveillance of Barrett’s Esophagus”

  1. New HGD Patient Says:
    November 4th, 2008 at 11:44 pm

    Newly diagnosed with HGD – am under surveillance currently, have had 3 biopsies in last 6 months as well as Ultrasound, all showing HGD – no evidence of invasion or cancer. My specialist says to just keep doing surviellance right now as there is nothing visibly worrysome right now. Am researching all new interventions – but it is so confusing….hopefully this new site will help those of us faced with such a hard decision to make to be able to take the right road to a successful approach eliminating the risk of HGD progressing. I will be watching this site regularly for more insight into all the new interventions.

  2. Wessel Bentley Says:
    May 24th, 2009 at 7:25 am

    Greetings from South Africa. Last week I was diagnosed with BE with no dysplasia. I also have a hiatus hernia. My GI prescribed Altosec treatment and will reassess me in 1 year. May either Endoscopic Mucosal Resection or ablation therapy be an option for me now to “get rid” of the Barretts? Obviously I will still live with my new lifestyle, diet and medication.

  3. emontgo2 Says:
    May 24th, 2009 at 12:13 pm

    Hi! Right now, we have NOT been offering endoscopic mucosal resection and radiofrequency ablation (BarrX) routinely to people with Barrett’s with NO dysplasia. The reason for this is that these things have some complications and the risk of any person with Barrett’s esophagus progressing to cancer is low (lower than the risk of a complication from these treatments). Take a look at the section that Dr. Dunbar prepared on radiofrequency ablation (BarrX) and you will read about some people who have had some real problems with it. Of course, many people do not have these problems. Dr. Dunbar may have some other commensts to add in due course.
    E. Montgomery, MD

  4. David Says:
    July 18th, 2010 at 2:47 pm

    Thanks for posting these guidelines. It’s nice to have what my doctor told me reaffirmed.

  5. salsa On2 Says:
    December 3rd, 2010 at 3:54 pm

    My wife is scheduled for an endoscopy. It’s good thing she doesn’t have any of these other complications.

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