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October 24th, 2011

Is it time to stop surveying Barrett esophagus?

One area of gastroenterology that is guided more by dogma than evidence regards surveillance of nondysplastic Barrett esophagus (BE). Surveillance of BE lesions is widely practiced, despite a large body of evidence that the practice is not cost-effective, the cancer risk from BE is very low, and the life expectancy of BE patients is normal. Even guidelines of professional societies (the AGA, ASGE, and ACG) do not endorse such surveillance, but instead view it as an optional strategy.

Now, a new study shows that cancer risk from BE is much lower than the already low rate we had been estimating  (see summary in Journal Watch Gastroenterology).

Based on these emerging facts, I’d like to generate a discussion regarding these questions:
1. Should we be screening for BE, and, if so, in whom?
2. In patients discovered to have nondysplastic BE, should we be doing surveillance?
3. If we do surveillance, how often should it be done?
4. If we recommend no surveillance, what should we be telling these patients?

I look forward to your discussion.

5 Responses to “Is it time to stop surveying Barrett esophagus?”

  1. Amar says:

    I’m not a doctor but the thought of money being detrimental to the screening for BE is scary….On the other hand, I’m a business owner and understand how business runs!! Mmmmm…interesting discussion. I’ll keep checking in to see how it unfolds.

  2. Jim Eisenberg says:

    I, too, am not a doctor, but I have Barrett esophagus. I’ve been having periodic screenings at my gastroenterologist’s suggestion because my father had esophageal cancer. The incidence of cancer in a population may be low, but it needs to be a decision the doctor and patient make together, depending on the patient’s circumstances and medical history.

  3. Carlo Saitto says:

    I think this issue is exemplary of how different points of view can be conflicting. On one side the societal perspective suggests continuing monitoring of BE isn’t worthwhile, the balance being between effectiveness and cost. On the other side the individual perspective affirms: “a low, or very low risk isn’t no risk at all therefore I’d like to continue monitoring even if it produces little good unless the balance between harm and good is decidely shifted”. The sound rationale against PSA screening conjugates the societal perspective: “it is useless” with the individual perspective: “it can do more harm than good”. Until harm from BE monitoring is documented a clearcut position on this issue will be difficult at a clinical level although I feel there is now adequate evidence to reconsidere BE monitoring in the coverage of Health Plans

  4. zhiwei wu says:

    We should stop surveying Barrett esophagus,but it is not now,why?TO some patient,it saves money,to others,lt means the lost of the chance of early detection for cancer。so,at least by now,we should continue it,but not to all patient。Who should?maybe
    patient with high risks into tumor?Now,who is patient with high risks into tumor?it is the key,if we get the key,we solve the problem。

  5. N. David Charkes MD says:

    An asymptomatic person does not need a workup but should be endoscoped if a family history of BE exists. A person with esophagitis symptoms would likely be endoscoped; if dysplastic BE is found, that person needs
    followup and possible therapy. If non-dysplastic BE is found, we await the next controlled study to determine the appropriate next step. Simple.

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Gastroenterology Research: Author M. Brian Fennerty, M.D.

M. Brian Fennerty, MD

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NEJM Journal Watch Gastroenterology

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