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