GASTROENTEROLOGY ARTICLE OF THE WEEK
May 1, 2008
Wang KK, Sampliner RE. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett’s esophagus. Am J Gastroenterol 2008;103:788-797
1. After finding low grade dysplasia on BE biopsies
a. Repeat endoscopy should be in 1 month
b. If no dysplasia is found on repeat endoscopy, next EGD should be in 3 years
c. 40% of cases will have no dysplasia on repeat EGD
d. 2/3 of patients with LGD on index EGD had no dysplasia after 4 years
2. Screening for Barrett’s
a. It is possible to predict accurately who has a high likelihood of having Barretts
b. In the absence of reflux symptoms, Barrett’s is exceedingly rare
c. Caucasian males over the age of 40 with >13 years of heartburn symptoms are more likely to have Barrett’s
d. The annual incidence of Barrett’s per 100,000 is 3.6 in caucasians and 0.8 in African Americans
True or False
3. The yield of finding intestinal metaplasia in BE is lower in patients with short segment BE.
4. High grade dysplasia is associated with a 75% chance of esophageal malignancy
5. Surveillance endoscopy after establishing a diagnosis of BE results in great benefits to the patients.
6. If an irregular squamocolumnar junction, suggestive of Barrett’s esophagus is seen on endoscopy, the final endoscopy report should mention Barrett’s as a diagnosis
7. Pateints undergoing repeat EGD due to high grade dysplasia should have biopsies done every 1 cm.
8. An accepted surveillance protocol calls for 2 endoscopies one year apart and if no dysplasia, then repeat endoscopy in 3 years
9. After finding high grade dysplasia on raised mucosa, repeat EGD should be in 3 months.
10. A patient with BE and prior documentation of intestinal metaplasia who on repeat EGD is found not to have intestinal metaplasia requires no further surveillance.
11. Low grade dysplasia associated with ulceration or nodularity requires mucosal resection
12. Treatment of patients with BE should include frequent pH monitoring of the esophagus to confirm total absence of acid