From the Guidelines
Repeating an Esophagogastroduodenoscopy (EGD) in 1 year is appropriate for a patient with newly diagnosed Barrett's esophagus, as it allows for the establishment of a new baseline and confirmation of the initial findings. The management of Barrett's esophagus is guided by the presence and grade of dysplasia, with non-dysplastic cases typically undergoing surveillance EGDs every 3-5 years after the initial 1-year examination 1.
Key Considerations
- For patients with low-grade dysplasia, more frequent surveillance (every 6-12 months) is recommended, while high-grade dysplasia may necessitate intervention rather than surveillance alone 1.
- Systematic biopsies using the Seattle protocol (four-quadrant biopsies every 1-2 cm throughout the Barrett's segment) should be performed during follow-up EGDs.
- Patients should continue acid suppression therapy with a proton pump inhibitor to control reflux symptoms and potentially reduce disease progression risk.
- Lifestyle modifications, including weight loss, elevation of the head of the bed, avoiding meals before bedtime, and smoking cessation, are also crucial components of management.
Surveillance and Management
The surveillance interval may vary based on specific findings during the initial EGD and subsequent examinations. The goal of surveillance is to detect dysplasia or cancer at an early stage when it is more amenable to treatment. For patients with confirmed low-grade dysplasia, endoscopic eradication therapy should be considered, especially in those at high risk of progression 1.
Recent Guidelines and Recommendations
Recent data support the consideration of endoscopic eradication therapy in patients with Barrett's esophagus-related low-grade dysplasia on an individual basis, with radiofrequency ablation being the preferred method for ablative therapy 1. The decision to proceed with endoscopic eradication therapy or continue surveillance should be made through shared decision-making between the patient and the treating physician, taking into account the individual's risk factors, preferences, and values.
From the Research
Repeating EGD for Newly Diagnosed Barrett's Esophagus
- The decision to repeat an Esophagogastroduodenoscopy (EGD) in 1 year for a patient with newly diagnosed Barrett's esophagus depends on various factors, including the presence of dysplasia and the length of the Barrett's segment 2, 3.
- According to the American College of Gastroenterology guidelines, surveillance endoscopy is recommended at an interval of every 2 to 3 years for patients with no dysplasia 2.
- However, some studies suggest that repeat EGD may be considered in carefully selected patients with gastroesophageal reflux disease and ≥2 risk factors for Barrett's esophagus, potentially using nonendoscopic tools 4.
- The incidence of Barrett's esophagus on repeat EGD is relatively low, ranging from 1.7% to 3.4% in some studies 4, 5.
- The benefit of surveillance remains uncertain, and the efficacy of endoscopic surveillance for Barrett's esophagus is likely to remain unclear for a long time 2, 6.
Factors Influencing Repeat EGD
- The presence of dysplasia is a significant factor in determining the frequency of repeat EGD, with low-grade dysplasia requiring more frequent surveillance than no dysplasia 2, 3.
- The length of the Barrett's segment is also an important factor, with longer segments requiring more frequent surveillance 3.
- Patient demographics, such as age and sex, may also influence the decision to repeat EGD, with men being more likely to have Barrett's esophagus than women 4, 5.
Current Guidelines and Recommendations
- The American College of Gastroenterology recommends surveillance endoscopy at an interval of every 2 to 3 years for patients with no dysplasia, and more frequently for patients with low-grade or high-grade dysplasia 2.
- International guidelines recommend esophagogastroduodenoscopy (EGD) every 5 years in BE without dysplasia with 1 up to 3 cm of extension, every 3 years in BE without dysplasia with >3 up to 10 cm of extension, and every 6 to 12 months in BE with low-grade dysplasia 3.