Today, we are comparing Barrett's esophagus clinical practice guidelines from the American Gastroenterological Association (AGA) and the American College of Gastroenterology (ACG). For this side-by-side comparison, we are specifically focusing on surveillance of Barrett's esophagus.
The two guidelines were published a few years apart, in 2025 and 2022 respectively. While both guidelines provide recommendations on the surveillance of Barrett's esophagus, the ACG guidelines feature an overview of categories related to Barrett's esophagus, while the AGA guidelines focus exclusively on the surveillance of Barrett's esophagus.
Let's take a closer look at the AGA and ACG guidelines side by side to better understand the key differences between them.
Guidelines for Comparison
| Item | Surveillance of Barrett's Esophagus | Diagnosis and Management of Barrett's Esophagus |
|---|---|---|
| Authoring Organization | American Gastroenterological Association (AGA) | American College of Gastroenterology (ACG) |
| Publication Date | October 2025 | March 2022 |
| Links | Summary / Full Text | Summary / Full Text |
Key Comparisons
The most notable difference between the two guidelines is that the AGA guideline focuses on the surveillance of Barrett’s esophagus, whereas the ACG guideline includes recommendations on the surveillance of Barrett’s esophagus as a component of a broader scope.
The AGA guideline includes eight recommendations on the surveillance of Barrett’s esophagus. The ACG guideline includes 21 recommendations spread across five categories (Diagnosis, Screening, Surveillance, Treatment [Medical], Treatment [Endoscopic]). Of those 21 recommendations, six are included in the Surveillance category.
Below, you can view a direct comparison of the recommendations provided from the AGA and ACG guidelines regarding the surveillance of Barrett’s esophagus.
Comparison of Recommendations
| Item | AGA | ACG |
|---|---|---|
| Endoscopic Surveillance | In patients with NDBE, the AGA suggests performing endoscopic surveillance compared to no surveillance. In patients with columnar-lined esophagus <1 cm with intestinal metaplasia, the AGA suggests against surveillance endoscopy | We recommend a structured biopsy protocol be applied to minimize detection bias in patients undergoing endoscopic surveillance of BE. We suggest endoscopic surveillance be performed in patients with BE at intervals dictated by the degree of dysplasia noted on previous biopsies. We recommend that length of BE segment be considered when assigning surveillance intervals with longer intervals reserved for those with BE segments of <3 cm. |
| White Light Endoscopy | In patients undergoing surveillance endoscopy for BE, the AGA recommends using a combination of high-definition WLE plus CE compared WLE alone. | We recommend both white light endoscopy and chromoendoscopy in patients undergoing endoscopic surveillance of BE. |
| General Implementation Considarations for Endoscopic Surveillance | 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. | We could not make a recommendation on the use of wide-area transepithelial sampling with computer-assisted 3-dimensional analysis in patients undergoing endoscopic surveillance of BE. |
| Biomarkers | 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. | We could not make a recommendation on the use of predictive tools (p53 staining and TissueCyper) in addition to standard histopathology in patients undergoing endoscopic surveillance of BE. |
| Prevention of Progression | In adult patients with BE, the AGA suggests the use of daily PPI therapy compared with no PPI therapy for the prevention of neoplastic progression of BE. In patients with BE, the AGA suggests use of PPIs over surgery for the prevention of neoplastic progression to HGD or EAC. | N/A |
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