Barrett’s esophagus (BE) affects approximately 10% of adults with chronic GERD. The major concern for patients with BE is the potential for progression to esophageal adenocarcinoma (EAC). The prognosis of patients with EAC is related to the stage at diagnosis. The goal of ongoing surveillance in patients with BE is to detect EAC early.
In today's guidelines side-by-side comparison, we have compared the latest clinical practice guidelines from the American Gastroenterological Association (AGA) and the American Society of Gastrointestinal Endoscopy (ASGE) on the surveillance of BE. The recommendations made are meant to guide clinical practice, taking into consideration the unique desires and needs of individual patients.
Guidelines for Comparison
| Item | AGA Clinical Practice Guideline on Surveillance of Barrett's Esophagus | ASGE Guideline on Screening and Surveillance of Barrett's Esophagus |
|---|---|---|
| Authoring Society | American Gastroenterological Association | American Society of Gastrointestinal Endoscopy |
| Publication Date | October 2025 | September 2019 |
| Graded Recommendations | Yes | Yes |
| Uses GRADE | Yes | Yes |
| Links | Summary / Full Text | Summary / Full Text |
Key Takeaways
Screening for Barrett’s Esophagus
- Both societies suggest screening endoscopies for at-risk patients.
- AGA specifically recommend against doing a surveillance endoscopy in patients with columnar-lined esophagus <1 cm with intestinal metaplasia because of the low risk for progression.
Surveillance Endoscopy
- Both societies suggest surveillance endoscopy for patients with nondysplastic Barrett’s esophagus (NDBE).
- Both societies suggest that surveillance endoscopy should include a combination of high-definition white-light endoscopy (WLE) and chromoendoscopy (CE) with tissue sampling using a structured biopsy protocol. ASGE suggests a specific structured biopsy protocol—the Seattle biopsy protocol.
Wide-Area Transepithelial Sampling (WATS-3D)
- AGA does not recommend for or against WATS-3D in addition to tissue sampling using a structured biopsy protocol.
- ASGE suggests that WATS-3D may be used in addition to tissue sampling with the Seattle biopsy protocol to increase diagnostic yield.
Endoscopic Ultrasound (EUS)
- AGA does not address the use of EUS.
- ASGE recommends against the use of EUS to differentiate mucosal vs submucosal disease.
Volumetric Laser Endomicroscopy (VLE)
- AGA did not address the use of VLE and ASGE was unable to make a recommendation for or against the use of VLE.
Biomarkers (p53 gene tests and TissueCypher testing)
- Biomarkers were not addressed by the ASGE.
- AGA was unable to make a recommendation for or against the use of p53 testing and TissueCypher testing.
- Although alteration in the p53 tumor suppression gene may increase the risk of disease progression in patients with BE, it’s unclear at this time how the results of p53 testing should be used to guide management.
- More studies are needed to determine if TissueCypher testing can accurately predict progression in patients with BE.
Comparison of Recommendations
| Type | ASGE | AGA |
|---|---|---|
| Screening for Barrett's Esophagus | There is insufficient evidence on the effectiveness of screening for BE. However, if screening endoscopy for BE is performed, we suggest a screening strategy that identifies an at-risk population. An at-risk population is defined as individuals with a family history of EAC or BE (high risk) or patients with GERD plus at least 1 other risk factor (moderate risk). | In patients with columnar-lined esophagus <1 cm with intestinal metaplasia, the AGA suggests against surveillance endoscopy. |
| Endoscopy | In patients with nondysplastic BE, we suggest performing surveillance endoscopy compared with no surveillance. In patients with BE undergoing surveillance, we recommend using CE or virtual chromoendoscopy (VC) in addition to WLE and biopsy specimens obtained using the Seattle protocol compared with WLE and biopsy specimens obtained using the Seattle protocol alone. In patients with BE undergoing surveillance, we suggest against routine use of confocal laser endomicroscopy compared with white-light endoscopy with Seattle protocol biopsy sampling. | In patients with NDBE, the AGA suggests performing endoscopic surveillance compared to no surveillance. In patients undergoing surveillance endoscopy for BE, the AGA recommends using a combination of high-definition WLE plus CE compared to WLE alone. |
| Wide-Area Transepithelial Sampling | In patients with known or suspected BE, we suggest using WATS-3D in addition to Seattle protocol biopsy sampling compared with white-light endoscopy with Seattle protocol biopsy sampling. | In patients undergoing surveillance endoscopy for BE, the AGA makes no recommendation for or against the use of WATS-3D as an adjunctive sampling technique to a structured biopsy protocol. |
| Endoscopic Ultrasound | In BE patients with high-grade dysplasia/IMC or nodules, we recommend against routine use of EUS to differentiate mucosal vs submucosal disease. | Not addressed. |
| Volumetric Laser Endomicroscopy (VLE) | In patients with BE undergoing surveillance, there is insufficient evidence to recommend for or against routine VLE. | Not addressed. |
| Biomarkers | Not directly addressed, but noted as an area to be explored in the future. | In patients diagnosed with NDBE, BE with IND or BE with LGD, the AGA makes no recommendation for or against the routine use of p53 assessment as an adjunct test to histopathology to predict progression to HGD or EAC. In patients diagnosed with NDBE, BE with IND or BE with LGD, the AGA makes no recommendation for or against the routine use of TissueCypher testing as an adjunct test to histopathology. |
That concludes our side-by-side comparison on the surveillance of BE. Don’t forget to sign up for alerts to stay informed on the latest published guidelines and articles.
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