Barrett's esophagus: new guidance on screening and surveillance

  • Qumseya B & al.
  • Gastrointest Endosc
  • 1 Sep 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • The American Society for Gastroenterology Endoscopy (ASGE) has issued updated guidelines on screening and surveillance in Barrett's esophagus (BE).

Why this matters

  • Recent advances have addressed limitations in previous screening and surveillance regimens.

Key points

  • Surveillance should be performed on patients with nondysplastic BE (conditional).
  • Not enough evidence exists to recommend screening for BE, but if screening is performed, it should include identification of individuals with a family history of esophageal adenocarcinoma or BE, or patients with GERD and ≥1 additional risk factor.
  • Surveillance:
    • Chromoendoscopy should be used with virtual chromoendoscopy and Seattle protocol biopsy sampling, as opposed to white-light endoscopy with Seattle protocol biopsy sampling (strong).
    • White-light endoscopy with Seattle protocol biopsy sampling should be favored over confocal laser endomicroscopy (conditional).
  • Endoscopic ultrasound should not be routinely used to differentiate mucosal and submucosal disease in patients with BE with high-grade dysplasia/intramucosal cancer or nodules (strong).
  • When BE is known or suspected, wide-area transepithelial sampling with computer-assisted 3-dimensional analysis and Seattle protocol biopsy is recommended over white-light endoscopy and Seattle protocol biopsy sampling (conditional).
  • There is insufficient evidence to recommend for or against the routine use of volumetric laser endomicroscopy in surveillance of patients with BE.

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