Monitoring

Surveillance of patients with Barrett esophagus is controversial. Practitioners should have a detailed discussion with the patient about the implications, efficacy, costs, risks, and benefits of surveillance strategies.

  • There is no conclusive evidence that surveillance reduces mortality from esophageal adenocarcinoma.

  • The American College of Gastroenterology and the European Society of Gastrointestinal Endoscopy recommend endoscopic surveillance every 3 to 5 years for nondysplastic Barrett esophagus, depending on the length of the Barrett esophagus segment. Endoscopic surveillance should be performed with high-definition white light endoscopy and using a systematic protocol for biopsies: four-quadrant biopsies at 2 cm intervals in patients without dysplasia, and 1 cm intervals in patients with previous history of dysplastic Barrett esophagus.[7][32]​​

Patients whose biopsies show indefinite for dysplasia:[7][32]​​

  • A second gastrointestinal expert pathologist should review the biopsies.

  • Should undergo a course of acid suppression therapy with proton-pump inhibitors.

  • Should then be re-evaluated with extensive biopsies in 3 to 6 months after optimization of acid-suppressive therapy.

  • If a subsequent endoscopy and biopsies at 3 to 6 months reveal no definite dysplasia, surveillance interval for nondysplastic Barrett esophagus should be followed. If repeat biopsies demonstrate indefinite for dysplasia again, a surveillance interval of 12 months is advised.

  • The National Institute for Health and Care Excellence (NICE) in the UK suggests considering endoscopic surveillance at an interval of 6 months with dose optimization of acid-suppressant medication.[33]

Patients with low-grade dysplasia:[7][52]

  • Acid suppression with proton-pump inhibitors is recommended.

  • Endoscopic surveillance with systematic biopsies is recommended 1 year after endoscopic eradication therapy, and every 2 years thereafter.

Patients with high-grade dysplasia:[7][52]

  • Endoscopic surveillance should be repeated 3 months, 6 months, and 12 months after endoscopic eradication therapy, and annually thereafter.

Use of this content is subject to our disclaimer