ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

TLDR

Barrett’s esophagus is a common gastroenterological condition, and this guideline offers a pragmatic framework for its management despite limited evidence. The guideline updates ACG recommendations for Barrett’s esophagus care and proposes post‑ablation surveillance intervals. It endorses high‑risk screening, discourages routine biomarker panels or advanced imaging beyond high‑definition endoscopy, recommends endoscopic ablation for high‑grade dysplasia and T1a cancer, and suggests post‑ablation surveillance intervals. Recent evidence shows low malignant risk in nondysplastic BE, leading to 3‑5‑year surveillance intervals, and supports endoscopic ablation for low‑grade dysplasia while still allowing surveillance.

Abstract

Barrett's esophagus (BE) is among the most common conditions encountered by the gastroenterologist. In this document, the American College of Gastroenterology updates its guidance for the best practices in caring for these patients. These guidelines continue to endorse screening of high-risk patients for BE; however, routine screening is limited to men with reflux symptoms and multiple other risk factors. Acknowledging recent data on the low risk of malignant progression in patients with nondysplastic BE, endoscopic surveillance intervals are attenuated in this population; patients with nondysplastic BE should undergo endoscopic surveillance no more frequently than every 3-5 years. Neither routine use of biomarker panels nor advanced endoscopic imaging techniques (beyond high-definition endoscopy) is recommended at this time. Endoscopic ablative therapy is recommended for patients with BE and high-grade dysplasia, as well as T1a esophageal adenocarcinoma. Based on recent level 1 evidence, endoscopic ablative therapy is also recommended for patients with BE and low-grade dysplasia, although endoscopic surveillance continues to be an acceptable alternative. Given the relatively common recurrence of BE after ablation, we suggest postablation endoscopic surveillance intervals. Although many of the recommendations provided are based on weak evidence or expert opinion, this document provides a pragmatic framework for the care of the patient with BE.