The authors of updated guidelines* for the diagnosis and management of Barrett oesophagus (BO) have recommended that dysplasia of any grade detected on BO biopsies be confirmed by a second pathologist who has expertise in gastrointestinal pathology.

In the new American College of Gastroenterology guideline – developed by Nicholas J. Shaheen, M.D., M.P.H., from the University of North Carolina at Chapel Hill, and colleagues, and published in the April issue of the American Journal of Gastroenterology – screening methods have been broadened and guidance has been updated on intervals and techniques of surveillance for patients with BO.

Acceptable screening modalities for BO now include non-endoscopic methods. Both white light endoscopy and chromo-endoscopy are recommended in patients undergoing endoscopic surveillance of BO. Length of BO segment should be considered when assigning surveillance intervals, with longer intervals reserved for those with BO segments <3 cm.

Endoscopic eradication therapy is recommended in patients with BO with high-grade dysplasia or intra-mucosal cancer.

For patients with BO who have completed successful endoscopic eradication therapy, an endoscopic surveillance program is recommended.

“This revised guideline synthesizes current best practices in the management of BO, with several key changes since the last iteration that reflect our evolving knowledge base,” the authors noted.


Shaheen et al: Diagnosis and Management of Barrett’s Esophagus: An Updated ACG