Strategies to prevent Barrett’s esophagus associated esophageal adenocarcinoma

Table 1 Comparison of major society guidelines on screening, surveillance, and management of Barrett’s esophagus

	ACG[10], 2022	ASGE[41], 2019	ESGE[42], 2017	BSG[40], 2014
Screening recommendations	Men with chronic GERD and ≥ 2 risk factors (age > 50, White race, obesity, smoking, family history)	Similar to ACG; shared decision-making emphasized	GERD with ≥ 1 risk factor (family history, male sex, obesity, age > 50, smoking)	Longstanding GERD with multiple risk factors; no general population screening
Screening modality	High-definition white light endoscopy + Seattle protocol biopsies	Endoscopy preferred; non-endoscopic tools under evaluation	Endoscopy with biopsies; non-endoscopic tests promising but investigational	Endoscopy and systematic biopsies
Surveillance of NDBE	Every 3-5 years	Every 3-5 years	Every 3 years	3-5 years depending on segment length and risk
Management of LGD	Confirm by expert pathology; recommend RFA or continued surveillance	Recommend RFA; confirmation by expert pathologist essential	Ablation preferred; mandatory second pathologist confirmation	Surveillance or ablation based on shared decision
Management of HGD/IMC	EET preferred over surgery	Endoscopic therapy first-line	Endoscopic therapy preferred; surgery if technically unfeasible	Endoscopic therapy recommended
Role of biomarkers	May aid in select cases; not standard of care	Under active investigation	Considered promising but not validated for routine use	Not routinely recommended
Role of AI/emerging tools	Recognized as promising adjuncts; not yet standard	Potential role noted	Await further validation	Not addressed

ACG: American College of Gastroenterology; ASGE: American Society for Gastrointestinal Endoscopy; ESGE: European Society of Gastrointestinal Endoscopy; BSG: British Society of Gastroenterology; GERD: Gastroesophageal reflux disease; NDBE: Non-dysplastic Barrett’s esophagus; LGD: Low-grade dysplasia; RFA: Radiofrequency ablation; HGD: High-grade dysplasia; IMC: Intramucosal carcinoma; EET: Endoscopic eradication therapy; AI: Artificial intelligence.