Management strategies of Barrett's esophagus

Table 1 Guidelines for evaluation and management of Barrett’s esophagus

	ACG	ASGE	AGA	BSG
No-dysplasia	Two esophageal examination with biopsy within 1 yr and follow up with endoscopy every 3 yr	Two consecutive esophageal examination with biopsy within 1 yr and follow up with endoscopy every 3 yr	Assess within 1 yr and if no dysplasia, defer for 5 yr or until cancer therapy is not possible of life expectancy is limited	Surveillance every 2 yr, if appropriate
Indefinite	-	Repeat biopsy after 8 wk of acid suppression, if evidence of acute inflammation due to gastro-esophageal acid reflux	-	Assess with extensive biopsies after course of proton pump inhibitors and return to routine surveillance, if no definite dysplasia at 6 mo
LGD	Treat based on highest grade of dysplasia seen on two esophageal examinations within 6 mo, with pathologist’s confirmation, and follow up with endoscopy every year until dysplasia is absent on two subsequent examinations	Follow up after 6 mo with concentrated biopsies in area of dysplasia; follow up every 12 mo if dysplasia persists	Assess in 1 yr and re-examine every year if dysplasia is confirmed by two pathologists (if there is disagreement about the presence of dysplasia then re-examine in 2 yr)	Extensive biopsy after intensive acid suppression for 8-12 wk; surveillance every 6 mo if dysplasia persist; surveillance intervals of 2-3 yr if regression occurs on two sequential examinations
HGD	Document any mucosal irregularities, repeat esophageal examination with biopsy within 3 mo, with pathologist’s confirmation, to eliminate the possibility of cancer; follow up with endoscopic mucosal resection in the case of any mucosal irregularity; then intensive endoscopic surveillance every 3 mo or an intervention, such as esophagectomy or ablation, in the case of flat mucosa	Diagnosis should be confirmed by a pathologist; surgical candidates can choose to have a surgery or endoscopic therapy; follow up patients who choose surveillance every 3 mo for 1 yr with several large biopsies every 1 cm along esophagus; after 1 yr without cancer detection, surveillance duration can be lengthened, provided dysplastic changes are absent on two subsequent examinations	Diagnosis should be confirmed by two pathologists; patients should be treated with surgical resection or endoscopic therapy; surveillance can be offered provided follow up with endoscopy is every 3 mo with a minimum of eight biopsies every 2 cm along esophagus	Esophagectomy recommended if changes persist after intensive acid suppression, if confirmed by two pathologists, and if patient considered fit for surgery; if unfit for surgery, use endoscopic ablation or mucosal resection

ACG: American College of Gastroenterology; ASGE: American Society for Gastrointestinal Endoscopy; AGA: American Gastroenterological Association; BSG: British Society of Gastroenterology; LGD: Low-grade dysplasia; HGD: High-grade dysplasia.