ACG Barrett's Esophagus Guideline Gets Facelift

The American College of Gastroenterology (ACG) recently updated its guidelines for best practices for diagnosis and management of patients afflicted with Barrett’s esophagus (BE).

The latest guideline makes evidence-based recommendations on diagnosis, screening surveillance, and therapy, including chemoprevention, endoscopic therapy, surgical therapy, and management of BE following endoscopic therapy.

Furthermore, the guideline suggests endoscopists who actually administer endoscopic ablative procedures should also provide endoscopic mucosal resections.

The published BE guideline includes the following major clinical implications:

· These guidelines continue to endorse screening of high-risk patients for BE; however, routine screening is limited to men with reflux symptoms and multiple other risk factors.

· Acknowledging recent data on the low risk of malignant progression in patients with nondysplastic BE, endoscopic surveillance intervals are attenuated in this population; patients with nondysplastic BE should undergo endoscopic surveillance no more frequently than every 3-5 years.

· Neither routine use of biomarker panels nor advanced endoscopic imaging techniques (beyond high-definition endoscopy) is recommended at this time.

· Endoscopic ablative therapy is recommended for patients with BE and high-grade dysplasia, as well as T1a esophageal adenocarcinoma.

· Based on recent level 1 evidence, endoscopic ablative therapy is also recommended for patients with BE and low-grade dysplasia, although endoscopic surveillance continues to be an acceptable alternative.

· Given the relatively common recurrence of BE after ablation, we suggest post ablation endoscopic surveillance intervals.

There are several differences between this set of guidelines and its previous version, namely the expanded use of endoscopic ablative therapy, streamlined approaches to screening, and a better understanding of the impact of gender and anthropomorphics on risk.

However, the primary difference is the recommendation that it is no longer necessary for female patients with GERD symptoms to undergo routine screening.