Management of Barrett's Esophagus

Definition and Risk Factors

Barrett's esophagus is an indication for life-long endoscopic surveillance due to its significant risk for progression to esophageal adenocarcinoma, as recommended by the American Gastroenterological Association 1, 2

Endoscopic surveillance is recommended for all patients with Barrett's esophagus to monitor for progression to dysplasia and adenocarcinoma, with a frequency of every 2-3 years for long segment Barrett's (≥3 cm) and every 3-5 years for short segment Barrett's (<3 cm) 1, 2, 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 or suspected dysplasia, as recommended by the American Gastroenterological Association 2, 3

The American Gastroenterological Association recommends against attempts to eliminate esophageal acid exposure through high-dose PPIs or antireflux surgery for the prevention of esophageal adenocarcinoma 5
Antireflux surgery is not more effective than medical GERD therapy for the prevention of cancer in Barrett's esophagus, according to the American Gastroenterological Association 2, 4
Medical therapy with proton pump inhibitors (PPIs) is the cornerstone of treatment for patients with Barrett's esophagus, as recommended by the American Gastroenterological Association 4

For patients with confirmed high-grade dysplasia, endoscopic eradication therapy with radiofrequency ablation (RFA), photodynamic therapy (PDT), or endoscopic mucosal resection (EMR) is recommended rather than surveillance, as recommended by the American Gastroenterological Association 6, 7
EMR is recommended for patients who have dysplasia in Barrett's esophagus associated with a visible mucosal irregularity to determine the T stage of the neoplasia, according to the American Gastroenterological Association 7

When Barrett's esophagus is detected, patients should receive an early outpatient appointment (ideally within 4-6 weeks) to discuss the implications of this diagnosis, including the low but significant cancer risk, possible lifestyle changes, and surveillance recommendations, as recommended by the American Gastroenterological Association 1