title: Endoscopic follow-up of Barrett's esophagus: protocol and implications.
abstract: The purpose of endoscopic surveillance in Barrett's esophagus is to detect dysplasia and to diagnose carcinoma in an early, treatable stage. Prospective trials that study the efficacy of a surveillance program in reducing mortality from esophageal adenocarcinoma are lacking. Retrospective studies have shown a significantly better outcome in patients with esophageal cancer that is detected during a surveillance program. Obviously, surveillance is only indicated for those patients fit enough to undergo esophagectomy if high-grade dysplasia (HGD) or malignancy is detected. There is no consensus upon what to do with HGD: some recommend esophagectomy when HGD is diagnosed, because an important proportion of these patients host an adenocarcinoma; others feel that histological proof of malignancy should be established before esophagectomy is proposed. Dysplasia is not a uniform process, causing sampling problems. Using a strict biopsy protocol is helpful to differentiate HGD from carcinoma, but contradictory results about this type of rigorous biopsy protocol have been published. Most groups propose four biopsy specimens, in a circular fashion, from every 2 cm of the Barrett-epithelium, with additional biopsies from any mucosal abnormality. Patients with long-segment Barrett's esophagus need endoscopic surveillance, even if they underwent antireflux surgery. At this moment there are not enough data to support a systematic surveillance of patients with short-segment's Barrett's esophagus. The following endoscopic strategy can be proposed. No dysplasia: surveillance every 2 years. Low-grade dysplasia: surveillance every year; in these cases it is recommended to repeat four-quadrant biopsies at 1 cm interval if numerous biopsies reveal dysplasia to detect foci of HGD/cancer. High-grade dysplasia: repeat immediately four-quadrant biopsies at 1 cm interval; if HGD is confirmed esophagectomy is advised to a patient with acceptable operative risk. Ablation therapy remains experimental.
authors.affiliation: Department of Gastroenterology, University Hospital Gent, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: De Looze
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology*; D001471:Barrett Esophagus / Q000175:diagnosis / Q000473:pathology*; D001707:Biopsy, Needle; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000473:pathology*; D004945:Esophagoscopy / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D017410:Practice Guidelines as Topic; D012680:Sensitivity and Specificity