Barrett's esophagus - Who, how, how often and what to do with dysplasia?

Abstract

When I see a patient with chronic reflux symptoms, I do discuss the possibility of screening for BE, and outline what would happen if we did find the condition, or if we found dysplasia or adenocarcinoma. In patients with known BE, I screen them every two years with endoscopy and four-quadrant biopsies every 2 cm, plus biopsies of any suspect lesions. I also ensure they are on long-term proton pump inhibitor therapy. After a number of negative endoscopies, I may increase the interval of screening to every three to four years. If I find low-grade dysplasia, I arrange for a repeat endoscopy in six months. If HGD is seen in a nodule, after an endoscopic ultrasound has ruled out metastatic disease, I will then discuss treatment options, including surgery and endoscopy, making sure they are aware that endoscopic therapies are stilt relatively new and long-term data are not yet available. If HGD is found in random biopsies, I will again discuss options, but often repeat the endoscopy in three months with repeat biopsies. If the dysplasia is still present, I will outline options such as endoscopic mucosal resection of the entire BE, and/or PDT, versus surgical esophagectomy. © 2006 Pulsus Group Inc. All rights reserved.