Barrett Esophagus
Clinical
- 2008 Recommendations of the Practice Parameters Committee of the American College of Gastroenterology (Wang 2008)
- No dysplasia
- Repeat endoscopy with biopsies within one year then every 3 years
- Indeterminate or low grade dysplasia
- Anti-reflux therapy with repeat endoscopy and biopsies every 6 months
- If still present, repeat above
- If resolved for two consecutive sets of biopsies, repeat endoscopy with biopsy every 3 years
- High grade dysplasia
- Anti-reflux therapy with repeat endoscopy and biopsies after 3 months
- If persistent or multiple sites involved, repeat endoscopy and biopsies every 3 months or consider endoscopic mucosal resection
- Intramucosal carcinoma
- Consider endoscopic mucosal resection or equivalent
- Adenocarcinoma invasive into submucosa
- As many as 30-40% of patients with high grade dysplasia are found to have carcinoma on resection
- Only 13% of these are invasive into submucosa or deeper (Konda 2008)
- One meta-analysis finds an incidence of 6 cases of invasive carcinoma per 100 patient-years for the first few years (Rastogi 2008)
- Some studies find a low rate of development of dysplasia and carcinoma in patients with no evidence of dysplasia at presentation
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