ASGE Develops Screening and Surveillance Guideline for Barrett Esophagus

The American Society for Gastrointestinal Endoscopy has released a guideline on the screening and surveillance of Barrett esophagus (BE). The guideline highlights the role and impact of screening and surveillance, as well as the use of advanced imaging and sampling modalities.

The authors developed the guideline based on the following 5 clinical questions:

• What is the role of surveillance endoscopy in patients with nondysplastic BE compared with no surveillance in decreasing the rate of cancer progression, esophageal adenocarcinoma-related mortality, and all-cause mortality?
• What is the role of screening for BE in the general population and at-risk populations compared with no screening in decreasing the rate of cancer progression and overall mortality?
• What is the role of advanced imaging technologies in improving the detection of dysplasia in BE patients undergoing surveillance?
• What is the role of wide-area transepithelial sampling in improving dysplasia detection rates?
• What is the role of endoscopic ultrasonography in staging BE patients with dysplasia and early esophageal adenocarcinoma?

The authors conducted systematic reviews on the available literature for each question.

Among the recommendations based on the review are the following:

• Surveillance endoscopy is suggested over no surveillance among patients with nondysplastic BE.
• The use of chromoendoscopy, including virtual chromoendoscopy and Seattle protocol biopsy sampling, is suggested over white-light endoscopy with Seattle protocol biopsy sampling among patients with BE who are undergoing surveillance.
• Routine use of confocal laser endomicroscopy is not suggested for patients with BE undergoing surveillance.
• Routine use of endoscopic ultrasonography to differentiate between mucosal and submucosal disease among patients with BE who have high-grade dysplasia/ intramucosal cancer or nodules is not recommended.
• The use of wide-area transepithelial sampling-3D with Seattle protocol biopsy sampling is recommended over white-light endoscopy with Seattle protocol biopsy sampling among patients with known or suspected BE.

“Before we embrace the new generation of less-invasive and potentially less-expensive screening techniques and replace our current approach of using standard endoscopy for screening, these new techniques need to demonstrate high diagnostic performance characteristics, easy implementation at a primary care level, high uptake in the at-risk population, and low cost,” the authors wrote.

—Colleen Murphy

Reference:

Qumseya B, Sultan S, Bain P, et al; ASGE Standards of Practice Committee. ASGE guideline on screening and surveillance of Barrett’s esophagus. Gastrointest Endosc. 2019;90(3):335-359.e2. doi:10.1016/j.gie.2019.05.012.