Diagnosis and Management of Barrett’s Esophagus

1. BE should be diagnosed when there is extension of salmon-colored mucosa into the tubular esophagus extending ≥1 cm proximal to the gastroesophageal junction with biopsy confirmation of IM.

2. Endoscopic biopsy should not be performed in the presence of a normal Z line or a Z line with <1 cm of variability.

3. In the presence of BE, the endoscopist should describe the extent of metaplastic change including circumferential and maximal segment length using the Prague classification.

4. The location of the diaphragmatic hiatus, gastroesophageal junction, and squamocolumnar junction should be reported in the endoscopy report.

5. In patients with suspected BE, at least 8 random biopsies should be obtained to maximize the yield of IM on histology. In patients with short (1–2 cm) segments of suspected BE in whom 8 biopsies are unattainable, at least 4 biopsies per cm of circumferential BE, and one biopsy per cm in tongues of BE, should be taken.

6. In patients with suspected BE and lack of IM on histology, a repeat endoscopy should be considered in 1–2 years of time to rule out BE.