New publications
Barrett's esophagus precedes esophageal cancer, but not all patients require removal of abnormal cells
Last reviewed: 02.07.2025
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
The new American Gastroenterological Association (AGA) Clinical Practice Statement on Endoscopic Eradication Therapy for Barrett's Esophagus and Related Neoplasms, published in the journal Gastroenterology, sets updated recommendations for patients with Barrett's esophagus.
Barrett's esophagus, a precursor to esophageal cancer, is a condition in which cells in the esophagus are replaced by non-carcinogenic abnormal cells. These cells can progress to a condition called dysplasia, which in turn can become cancerous. Dysplasia is considered low-grade or high-grade depending on the extent of the cellular changes.
"While the benefit is clear for patients with high-grade dysplasia, we suggest considering endoscopic eradication therapy for patients with low-grade dysplasia after a clear discussion of the risks and benefits of endoscopic therapy," said guideline author Dr. Tarek Savvas, associate professor of internal medicine at the University of Texas Southwestern Medical Center.
"A patient-centered approach ensures shared treatment decision making that takes into account both medical data and patient preferences and values. Observation is a reasonable option for patients who place a higher value on harms and a lower value on uncertain benefits in terms of reduced mortality from oesophageal cancer."
Endoscopic eradication therapy involves minimally invasive procedures such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), followed by ablation techniques (burning or freezing).
Key findings from the guide:
- For patients with low-grade dysplasia, either removal or cell monitoring may be appropriate. This decision should be made jointly by doctors and patients after discussing the risks and benefits of treatment.
- For patients with high-grade dysplasia, the AGA recommends endoscopic therapy to remove abnormal precancerous cells. Most patients undergoing endoscopic eradication can be safely treated with EMR, which has a lower risk of adverse events.
- Patients undergoing ESD may face an increased risk of strictures and perforations. The AGA recommends using ESD primarily for lesions suspected of containing cancer that invades deeper into the esophageal wall or for those in whom EMR has failed.
- Patients with Barrett's esophagus (dysplasia or early cancer) should be treated and followed by experienced endoscopists and pathologists with expertise in Barrett's neoplasia.
"We need to have discussions with patients in the clinic before they end up on a stretcher in the endoscopy suite. Patients need to be fully aware of the risks and benefits, both short-term and long-term, to make a decision about the best treatment approach for them. This decision often comes down to personal factors and values," added guideline author Dr. Joel Rubenstein, director of the Barrett's Esophagus Program at the University of Michigan.
The guide provides the following general recommendations for implementation:
- Smoking and obesity are risk factors for esophageal adenocarcinoma, so counseling patients to quit smoking and lose weight may help improve outcomes.
- In patients with Barrett's esophagus, reflux control should be optimized with both medication and lifestyle changes.