Guideline Video

Guideline Resources

  • Surveillance of Metaplastic and Premalignant Conditions of the Esophagus and Colorectum in Older Adults
  • American Gastroenterological Association
  • August 3, 2026
  • Summary
  • Full-text

Video Transcription

Just published August 3rd, 2026, the American Gastroenterological Association’s newest clinical practice update on Surveillance of Metaplastic and Premalignant Conditions of the Esophagus and Colorectum in Older Adults.

This clinical practice update reviews 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.

In today’s rapid update, we’ll just be going over a summary of the best practice advice statements so for the full clinical practice update, make sure to check it out on guidelinecentral.com

Let’s get started. 

  • Formal determination of comorbidities and use of life expectancy tools may help differentiate among older adults most likely to benefit vs those most likely to be harmed by surveillance. Real-world effectiveness and cost-effectiveness analysis in diverse populations would help with widespread implementation. 
  • The goal of endoscopic surveillance in Barrett's esophagus is to detect dysplasia and adenocarcinoma at an early and treatable stage. Endoscopic surveillance of Barrett's esophagus should follow current best practices in terms of imaging, tissue acquisition, and surveillance intervals. 
  • The choice to continue endoscopic surveillance of Barrett's esophagus should be based on shared decision-making that examines factors such as comorbidities, life expectancy, risks, and benefits, as well as patient preferences. 
  • Utilization of tools for prediction of dysplasia progression in Barrett's esophagus may help contextualize the time frame for the development of adenocarcinoma within an individual's life expectancy. 
  • Inability to tolerate endoscopic therapy, surgery, or oncologic interventions for esophageal adenocarcinoma should lead to cessation of Barrett's esophagus surveillance regardless of age. 
  • The decision to continue colorectal cancer screening in individuals >75 years old should be individualized, based on an assessment of benefits, screening history, comorbidities, and risks. 
  • The decision to continue surveillance of colorectal polyps in individuals >75 years old should be individualized, based on an assessment of benefits, polyp history, comorbidities, and risks. 
  • With increasing age, colonoscopy is associated with a higher incidence of adverse events regardless of the indication. Therefore, the clinical decision-making process for colonoscopy should be clearly documented in the electronic health record for individuals >75 years. 
  • Whenever possible, published studies of the use, effectiveness, deimplementation, and costs of colonoscopy in older adults should be used to inform practice decisions for patients and clinicians.

And there you have it. Make sure to check out the full clinical practice update from the American Gastroenterological Association and other related clinical decision support tools at guidelinecentral.com.

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