Review
Copyright ©2012 Baishideng Publishing Group Co.
World J Gastroenterol. Nov 21, 2012; 18(43): 6216-6225
Published online Nov 21, 2012. doi: 10.3748/wjg.v18.i43.6216
Table 1 Guidelines for evaluation and management of Barrett’s esophagus
ACGASGEAGABSG
No-dysplasiaTwo esophageal examination with biopsy within 1 yr and follow up with endoscopy every 3 yrTwo consecutive esophageal examination with biopsy within 1 yr and follow up with endoscopy every 3 yrAssess within 1 yr and if no dysplasia, defer for 5 yr or until cancer therapy is not possible of life expectancy is limitedSurveillance 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
LGDTreat 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 examinationsFollow up after 6 mo with concentrated biopsies in area of dysplasia; follow up every 12 mo if dysplasia persistsAssess 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
HGDDocument 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 mucosaDiagnosis 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 examinationsDiagnosis 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 esophagusEsophagectomy 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