Is it time to stop surveying Barrett esophagus?
Journal Watch Editors • October 24th, 2011
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.