The American Gastroenterological Association (AGA) just released new clinical guidance, Surveillance of Metaplastic and Premalignant Conditions of the Esophagus and Colorectum in Older Adults. The clinical practice update features nine best practice advice statements that resulted from a review of published literature and expert opinion. The best practice advice statements focus on gauging appropriateness for esophageal cancer and colorectal cancer surveillance, potential harms of surveillance, and more.

AGA states that additional guidance is needed regarding executing nuanced evaluations in clinical practice for the multidisciplinary considerations framing discussion on mortality and surveillance-related morbidity in the context of predicted life expectancy. For the complete look at the following guidance statements and their accompanying rationale, view the full-text version.

Guidance Statements from the 2026 Clinical Practice Update:
  • 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.

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