Surveillance of Metaplastic and Premalignant Conditions of the Esophagus and Colorectum in Older Adults

Document Overview

Document Title

Surveillance of Metaplastic and Premalignant Conditions of the Esophagus and Colorectum in Older Adults

Authoring Society

American Gastroenterological Association

Document Publication Date

Aug 3, 2026

Page Last Reviewed/Updated

Aug 4, 2026

Document Type

Consensus Statement

Country of Publication

United States

Full Text Freely Available

Yes

Full Text Guideline

doi.org/10.1016/j.cgh.2026.06.007

Source Citation

Calderwood, Audrey H et al. “AGA Clinical Practice Update on Surveillance of Metaplastic and Premalignant Conditions of the Esophagus and Colorectum in Older Adults: Expert Review.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, S1542-3565(26)00441-6. 3 Aug. 2026, doi:10.1016/j.cgh.2026.06.007

Document Scope, Criteria, and Use Cases

Document Objectives

The United States Census Bureau projects that the population of Americans ≥65 years old will grow 5 times faster than the total population, reaching 82 million by 2050 (23% of the population). Health care providers will increasingly need to discuss the cessation of cancer screening due to limited value in patients whose age or comorbidities preclude time to benefit from eradication of preneoplastic lesions. Although evidence supports colonoscopy's ability to reduce population-wide colorectal cancer mortality, high-quality data around endoscopic surveillance of Barrett's esophagus is more limited. In this Clinical Practice Update, we review practical approaches to assess appropriateness for colorectal cancer and esophageal cancer surveillance, the real-world yield of screening and/or surveillance in older adults, and the potential harms of surveillance. This expert review was commissioned and approved by the American Gastroenterological Association Institute Clinical Practice Updates Committee and the American Gastroenterological Association Governing Board to provide timely guidance on a topic of high clinical importance to the American Gastroenterological Association membership, and underwent internal peer review by the Clinical Practice Updates Committee and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. These Best Practice Advice statements were drawn from a review of the published literature and from expert opinion. Because systematic reviews were not performed, these Best Practice Advice statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations.

Scope

Assessment and Screening, Diagnosis, Management

Keywords

Esophageal cancer, colorectal cancer, colorectal neoplasm, esophageal adenocarcinoma

Inclusion Criteria

Male, Female, Adult, Older Adult

Health Care Settings

Ambulatory, Outpatient

Intended Users

Nurse, Nurse Practitioner, Physician, Physician Assistant