Page 6 - 03- Barrett Esophagus

ALERT
Endoscopic eradication not recommended for most BE without dysplasia; therapy should be
individualized. Continue surveillance in these patients.

SURGERY/OTHER PROCEDURES
Antireflux surgery such as fundoplication may control GERD symptoms but have not been
shown to reverse BE, decrease risk of cancer, or be superior to medical therapy (1)[A].
ALERT
Antireflux surgery does not appear to decrease risk of esophageal cancer.

Esophagectomy is definitive and can be offered as an alternative to endoscopic eradication
therapy for high-grade dysplasia (1)[B] or in patients for whom endoscopic treatment has
failed. Morbidity and mortality are higher than with endoscopic treatment.
– Preferred for patients with evidence of submucosal invasion (stage T1SM2 or higher) or
T1a patients with poor differentiation, lymphovascular invasion, or incomplete endoscopic
mucosal resection
– Added benefit of lymph node removal
– Mortality rate: <5% in patients with high-grade dysplasia who are otherwise healthy
– Serious postoperative complications: 30–50%
– Should ideally be performed by an experienced surgeon in a high-volume center (1)[A]

COMPLEMENTARY & ALTERNATIVE MEDICINE
A prospective study of 339 men and women with BE found those taking either a multivitamin,
vitamin C, or vitamin E once a day were less likely to develop EAC.

Geriatric Considerations
Surveillance or no treatment may be preferable to endoscopic eradication therapy or
esophagectomy in patients who are poor operative candidates. Discontinue surveillance in
patients who are not candidates for treatment.

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS
Surveillance (to detect high-grade dysplasia or early carcinoma), although controversial, is
recommended in patients with histologically confirmed BE, especially for those in high-risk
groups.
Surveillance intervals depend on grade of dysplasia (1)[C].
Patients diagnosed with BE on initial exam do not require endoscopy in 1 year (2)[C].
No dysplasia: Survey every 3 to 5 years.
– Discontinue surveillance if life expectancy is ≤5 years (4)[C].
Low-grade dysplasia: Survey every 6 to 12 months (2,3)[C],(4).
– Routine surveillance if patients have confirmed absence of low-grade dysplasia after two
consecutive endoscopies (4)[C]
Indefinite for dysplasia: Repeat after 3 to 6 months of increased acid suppression, and if
unchanged, survey every 12 months (4)[C].
High-grade dysplasia without eradication therapy: Survey every 3 months; with eradication