Recommended Frequency for EGD Monitoring in Barrett's Esophagus
The recommended frequency for EGD monitoring in Barrett's esophagus should be stratified based on the length of Barrett's segment and the presence or absence of dysplasia, with surveillance intervals ranging from 3-5 years for non-dysplastic short-segment Barrett's to every 3-6 months for high-grade dysplasia. 1, 2
Surveillance Intervals Based on Barrett's Characteristics
Non-dysplastic Barrett's Esophagus
- For short-segment Barrett's esophagus (<3 cm): Surveillance endoscopy every 3-5 years 1, 3
- For long-segment Barrett's esophagus (≥3 cm and <10 cm): Surveillance endoscopy every 2-3 years 1, 3
- For very long-segment Barrett's esophagus (≥10 cm): Referral to a Barrett's expert center for specialized surveillance 3
- For irregular Z-line/columnar-lined esophagus <1 cm: No routine surveillance recommended 3
Low-Grade Dysplasia (LGD)
- Confirm diagnosis with expert pathologist review on at least two separate endoscopies 1, 3
- If confirmed, endoscopic eradication therapy with ablation is recommended 3
- If surveillance is chosen instead of ablation, perform endoscopy every 6-12 months for the first year, then annually if dysplasia has not progressed 4, 5
High-Grade Dysplasia (HGD)
- Endoscopic ablation treatment is recommended to prevent progression to invasive cancer 3
- If surveillance is chosen instead of immediate treatment, perform intensive endoscopic surveillance every 3-6 months 4
- After successful endoscopic eradication therapy, follow-up at 1,2,3,4,5,7, and 10 years 3
Indefinite for Dysplasia
- Consider endoscopic surveillance at 6-month intervals with optimization of acid-suppressant medication 2
Biopsy Protocol for Surveillance
- Use high-resolution white light endoscopy for all surveillance procedures 2
- Obtain 4-quadrant biopsies every 2 cm of Barrett's segment for patients without known dysplasia 2, 1
- Obtain 4-quadrant biopsies every 1 cm for patients with known or suspected dysplasia 2
- Take separate, targeted biopsies of any mucosal irregularities or visible lesions 2, 1
- Document the extent of Barrett's using the Prague classification (circumferential and maximal extent) 1, 3
Post-Treatment Surveillance
After Endoscopic Eradication Therapy (EET)
- For patients with baseline HGD or esophageal adenocarcinoma (EAC): Surveillance at 1,2,3,4,5,7, and 10 years after treatment, then may discontinue 3
- For patients with baseline LGD: Surveillance at 1,3, and 5 years after treatment, then may discontinue 3
- First endoscopic follow-up after successful EET should be performed in an expert center 3
After Endoscopic Submucosal Dissection (ESD)
- For T1a EAC: First EGD at 6 months, then every 6 months for a total of 2 years, then annually 2
- For T1b EAC (<500 μm submucosal invasion): First EGD at 3 months, second at 6 months, then every 6 months for a total of 2 years 2
Special Considerations
- Consider discontinuing surveillance when the patient reaches 75 years of age or has a life expectancy less than 5 years 3
- Patients should be on at least daily proton pump inhibitor therapy during surveillance 1
- Adherence to recommended biopsy protocols is associated with higher rates of dysplasia and cancer detection 2
- Endoscopic surveillance can reduce mortality from esophageal adenocarcinoma through early detection of treatable cancers 2
Common Pitfalls to Avoid
- Inadequate biopsy sampling significantly reduces dysplasia detection rates 1
- Poor adherence to surveillance protocols is most common in high-risk patients (those with extensive Barrett's metaplasia) 2
- Failure to confirm dysplasia diagnosis by a second GI pathologist can lead to inappropriate management due to significant interobserver variability 1
- Not taking targeted biopsies of visible abnormalities can miss focal areas of dysplasia or early cancer 2