Role of Endoscopy in Barrett's Esophagus and Other Premalignant Conditions of the Esophagus

Publication Date: December 1, 2012

Recommendations

1. We suggest that endoscopic screening for BE can be considered in select patients with multiple risk factors for BE and EAC, but patients should be informed that there is insufficient evidence to affirm that this practice prevents cancer or prolongs life. (VL)
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2. We recommend no further endoscopic screening for BE after a screening examination with negative findings. (M)
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3. We recommend against a surveillance EGD 1 year after the initial diagnosis of NDBE. (M)
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4. We suggest that if patients with NDBE are enrolled in an EGD surveillance program, a surveillance EGD should be performed no more frequently than every 3 to 5 years, with white-light endoscopy and targeted plus 4-quadrant biopsies at every 2 cm of suspected BE. (L)
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5. We suggest that only patients with BE who are candidates for therapy if dysplasia is identified be enrolled in EGD surveillance programs. (VL)
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6. We suggest that patients with a diagnosis of BE IGD undergo additional evaluation to clarify the diagnosis. This may include additional pathology review, dose escalation of antisecretory therapy to eliminate confounding esophageal inflammation, and/or a repeat EGD and biopsy. (L)
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7. We recommend that an expert GI pathologist confirm the diagnosis of LGD and/or HGD. (M)
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8. We suggest that patients with LGD undergo a repeat endoscopy within 6 months to confirm the diagnosis, then annual surveillance endoscopy using a standard biopsy protocol. (M)
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9. We suggest that ablation be considered in select patients with LGD. Appropriate surveillance intervals after ablation are unknown. (L)
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10. We recommend that endoscopic resection of nodular dysplastic BE be performed to determine the stage of dysplasia before considering other ablative endoscopic therapy. (M)
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11. We suggest that local staging with EUS ± FNA is an option in select patients being considered for endoscopic ablative therapy. (VL)
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12. We recommend that eradication with endoscopic resection or RFA be considered for flat HGD in select cases because of its superior efficacy (compared with surveillance) and side effect profile (compared with esophagectomy). (M)
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13. We recommend against routine endoscopic surveillance in achalasia. (M)
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14. We recommend against endoscopic routine screening in patients with aerodigestive cancer. (M)
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15. We suggest that screening for esophageal carcinoma begin at age 30 in patients with tylosis. Surveillance intervals should be every 1 to 3 years. (L)
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16. We suggest that screening for esophageal carcinoma begin approximately 10 to 20 years after caustic injury and performed every 2 to 3 years. (L)
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Recommendation Grading

Disclaimer

Overview

Title

Role of Endoscopy in Barrett's Esophagus and Other Premalignant Conditions of the Esophagus

Authoring Organization

Publication Month/Year

December 1, 2012

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Emergency care, Hospital, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Diagnosis, Prevention

Diseases/Conditions (MeSH)

D001471 - Barrett Esophagus, D004938 - Esophageal Neoplasms, D004931 - Esophageal Achalasia

Keywords

Barrett's esophagus, esophageal adenocarcinoma, Esophageal cancer

Source Citation

Evans, J. A., Early, D. S., Fukami, N., Ben-Menachem, T., Chandrasekhara, V., Chathadi, K. V., … Cash, B. D. (2012). The role of endoscopy in Barrett’s esophagus and other premalignant conditions of the esophagus. Gastrointestinal Endoscopy, 76(6), 1087–1094. doi:10.1016/j.gie.2012.08.004