Management of Barrett's Esophagus

Medical Management for Non-Dysplastic Barrett's Esophagus

The American Gastroenterological Association recommends proton pump inhibitors (PPIs) as the cornerstone of medical therapy for Barrett's esophagus and should be used for symptom control of gastroesophageal reflux disease (GERD) 3, 4
There is insufficient evidence to recommend high-dose PPI therapy solely to prevent progression to dysplasia or cancer, as stated by the American College of Gastroenterology 1, 5
Antireflux surgery is not superior to medical therapy for preventing neoplastic progression of Barrett's esophagus and should not be offered for this purpose, according to the European Society of Gastrointestinal Endoscopy 6, 7
Antireflux surgery should only be considered in patients with poor or partial symptomatic response to PPIs, as recommended by the American College of Surgeons 5, 4

The American College of Gastroenterology recommends that all patients with Barrett's esophagus should undergo endoscopic surveillance to monitor for progression to dysplasia and adenocarcinoma 3
For non-dysplastic Barrett's esophagus, surveillance intervals should be every 3-5 years, as suggested by the British Society of Gastroenterology 3
Proper biopsy protocol includes 4-quadrant biopsies every 2 cm of Barrett's segment for patients without known dysplasia, and every 1 cm for patients with known dysplasia, according to the American Society for Gastrointestinal Endoscopy 8, 3

The European Society of Gastrointestinal Endoscopy recommends that radiofrequency ablation (RFA) should be offered to patients with confirmed low-grade dysplasia diagnosed from biopsy samples taken at two separate endoscopies 2, 7
Endoscopic resection of visible lesions should be offered as first-line treatment for high-grade dysplasia, as recommended by the American College of Gastroenterology 2, 7
Endoscopic ablation of any residual Barrett's esophagus should be offered after endoscopic resection, according to the American Society for Gastrointestinal Endoscopy 1, 2

The American College of Surgeons recommends that endoscopic resection should be offered as first-line treatment for T1a (intramucosal) esophageal adenocarcinoma 2
For T1b (submucosal) esophageal adenocarcinoma, esophagectomy should be offered to patients who are fit for surgery and at high risk of cancer progression, as suggested by the European Society of Surgical Oncology 2, 5

The American Gastroenterological Association states that there is insufficient evidence to support the use of aspirin, NSAIDs, or other chemopreventive agents specifically for Barrett's esophagus 1, 5
Patients should be screened for cardiovascular risk factors for which aspirin therapy might be indicated for other reasons, as recommended by the American Heart Association 1, 9

The British Society of Gastroenterology recommends that all patients should be offered an appointment to discuss management decisions 5, 3
When intervention is considered, therapeutic options should be discussed with both an endoscopist and a surgeon, as suggested by the American College of Surgeons 5

The American College of Gastroenterology advises against attempting to eliminate esophageal acid exposure through high-dose PPIs or antireflux surgery solely for the prevention of esophageal adenocarcinoma 1, 3
The European Society of Gastrointestinal Endoscopy recommends against using endoscopic ultrasonography (EUS) before endoscopic resection for staging suspected T1a esophageal adenocarcinoma 2, 7
The diagnosis of dysplasia should be confirmed by expert gastrointestinal pathologists before initiating treatment, as stated by the American Society for Gastrointestinal Endoscopy 2