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Watchful waiting no longer recommended for some high-risk Barrett's esophagus patients
Date:2/28/2011

not recommended.

If eradication therapy is not indicated, is not available or is declined by a patient with Barrett's esophagus, surveillance by endoscopy should be performed every three months in patients with high-grade dysplasia, every six to 12 months in patients with low-grade dysplasia, and every three to five years in patients with no dysplasia.

"The recommendations in the medical position statement were made under the assumption that a patient's diagnosis and the presence or absence of low and high grade dysplasia would be accurate to the highest degree possible using the best current standards of practice," according to Stuart J. Spechler, MD, AGAF, a member of the AGA Institute Medical Position Panel. High grade dysplasia is an abnormal growth that has a high risk for cancer development.

Most patients (70 to 80 percent) with high-grade dysplasia can be successfully treated with endoscopic eradication therapy. Esophagectomy (surgical removal of all or part of the esophagus) in patients with high-grade dysplasia is an alternative; however, current evidence suggests that there is less morbidity with ablative therapy.

Other findings of the medical position statement on the management of Barrett's esophagus include:

  • In patients with multiple risk factors associated with esophageal cancer (age ≥50 years, male gender, Caucasian, chronic gastroesophageal reflux disease [GERD], hiatal hernia, elevated body mass index and intra-abdominal distribution of body fat), AGA suggests screening for Barrett's esophagus. We recommend against screening the general population with GERD for Barrett's esophagus.
  • The diagnosis of dysplasia in Barrett's esophagus should be confirmed by at least one additional pathologist, preferably one who is an expert in esophageal histopathology.
  • For patients with Barrett's esophagus, GERD therapy with medication effective to treat GERD symptoms and to heal reflux is c
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Contact: Aimee Frank
media@gastro.org
301-941-2620
American Gastroenterological Association
Source:Eurekalert

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