Barrett's Esophagus

Patients who develop Barrett's esophagus should be entered into an endoscopic surveillance program, including endoscopic biopsy. For patients who do not develop dysplasia, we recommend surveillance every 3 years. Patients with low-grade dysplasia should be surveyed with endoscopy and biopsy every 6 months over the next year, then at 1-year intervals if there has not been progression to a higher grade of dysplasia. The role of endoscopic ablation therapy has yet to be defined. Because of the high risk (30% to 40%) of developing esophageal cancer among patients with high-grade dysplasia, we recommend esophagectomy for those who are medically fit to undergo this surgery. However, it is important that an expert pathologist confirms the diagnosis and that the operation is performed by a surgeon experienced in esophageal resection. For those who are not candidates for surgery or refuse it, we recommend consideration of endoscopic ablative therapy. The other option available is to continue surveillance at 3- to 6-month intervals with reconsideration of surgical or experimental ablative therapy if cancer develops (see Figure 1).