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Barrett’s esophagus can precede esophageal cancer, but not all patients need a procedure to remove abnormal cells

Experts call for an individualized approach to endoscopic eradication therapy.
Cropped photo of a man in white coat and rubber gloves standing with a modern endoscope
Cropped photo of a man in white coat and rubber gloves standing with a modern endoscope

AGA has published a new evidence-based Clinical Practice Guideline on Endoscopic Eradication Therapy of Barrett’s Esophagus and Related Neoplasia. This guideline, published in Gastroenterology, establishes updated guidance for Barrett’s esophagus patients. 

Key takeaways 

  • For patients with low-grade dysplasia, it may be appropriate to either remove or monitor the cells. This is a decision doctors and patients should make together after discussing the risks and benefits of treatment. 
  • For patients with high-grade dysplasia, AGA recommends endoscopic therapy to remove the abnormal pre-cancerous cells. 
  • Most patients undergoing endoscopic eradication can be safely treated with EMR, which has a lower risk of adverse events. Patients who undergo ESD can face an increased risk of strictures and perforation. AGA recommends reserving ESD primarily for lesions suspected of harboring cancers invading more deeply into the wall of the esophagus or those who have failed EMR. 
  • Patients with Barrett’s esophagus (dysplasia or early cancer) should be treated and monitored by expert endoscopists and pathologists who have experience in Barrett’s neoplasia. 

The guideline provides the following general implementation considerations: 

  • Tobacco use and obesity are risk factors for esophageal adenocarcinoma, so counseling patients to abstain from tobacco use and to lose weight can help improve outcomes. 
  • In patients with Barrett’s esophagus, reflux control should be optimized with both medication and lifestyle modifications. 

Check out AGA’s GI Patient Center resources: 

What is Barrett’s esophagus? 

What is an upper GI endoscopy?  

AGA clinical guidance

Find the latest evidence-based recommendations for treating your patients.