S3276 Review of American and International Guidelines for Endoscopic Management of Barrett's Esophagus

Abstract

Introduction: Gastroesophageal reflux disease (GERD) is seen in approximately 10 to 20 % of the Western population. Complications of GERD include Barrett’s esophagus (BE) and esophageal adenocarcinoma (EAC). EAC has been increasing in the past few decades and now encompasses over 60% of all esophageal cancers in the US. Dysplasia in BE further increases the risk of progression from low grade dysplasia (LGD) to high grade dysplasia (HGD) and eventually EAC.The objective of this study was to perform a review of the current guidelines from American and international gastroenterology societies for the endoscopic management of BE. Methods: Guidelines and recommendations from major American and other prominent international GI societies were reviewed from January 25th to 29th, 2021 on the management of BE. We included ACG, AGA, ASGE, ESGE, BSG, SFED, Japanese GI and Internal Medicine societies, CAG, and AMG. Results: While there is a common consensus among the international GI community in diagnosis and management of BE, there are also major notable differences. Screening for BE in the general population is usually not recommended but many suggest individualized assessment. The American societies generally manage nondysplastic Barrett’s esophagus (NDBE) with surveillance endoscopy every 3 to 5 years. However, the ASGE considers endoscopic ablation (RFA) in high-risk groups. After diagnosis of BE is made, the majority provide guidelines for surveillance intervals based on the presence and grading of dysplasia. The ESGE, BSG, and SFED provide varying intervals for NDBE based on BE segment length. Endoscopic eradication therapy (EET) is recommended by some societies for LGD, while all societies recommend it for HGD. Post-EET surveillance is often performed in practice, but officially recommended by 5 out of 9 societies. EAC only accounts for 5% of all esophageal cancers in Japan. Additionally, Japanese societies do not require intestinal metaplasia for diagnosis of BE and also have different endoscopic landmarks for the gastroesophageal junction, biopsy protocols, and histologic definition of BE. Conclusion: Most societies agree on endoscopic surveillance for NDBE and EET for HGD. Endoscopic therapy with RFA for NDBE is controversial and not widely accepted. However, EET for LGD is becoming more common in the US and some parts of Europe. BE in Japan is diagnosed and managed differently than in the West; further studies are warranted to provide a fair comparison.