The American Gastroenterological Association (AGA) has released an updated clinical practice guideline on surveillance of Barrett’s esophagus, the only known precursor to esophageal adenocarcinoma. The new guideline, which was published in Gastroenterology, emphasizes risk-based, individualized monitoring and the use of high-quality endoscopy to prevent progression to this highly lethal cancer. It marks a significant shift away from uniform surveillance practices toward a more personalized approach.
Led by Sachin Wani, MD, of the Division of Gastroenterology and Hepatology, University of Colorado, the multidisciplinary panel issued eight evidence-based recommendations and multiple implementation statements to guide clinicians in the long-term management of Barrett’s esophagus. “What’s novel here is our move away from a one-size-fits-all approach,” said Dr. Wani. “We focus on risk stratification and doing endoscopy right—because quality drives earlier detection of neoplasia and better outcomes.”
Guideline Recommendations
Among its key recommendations, the AGA advises continued endoscopic surveillance for patients with nondysplastic Barrett’s esophagus while recommending against routine monitoring for very short segments of columnar-lined esophagus measuring < 1 cm without evidence of neoplasia. For surveillance procedures, the guideline strongly recommends combining high-definition white light endoscopy with chromoendoscopy vs white light endoscopy alone.
While the panel favors the use of daily proton pump inhibitor (PPI) therapy over no PPI therapy or surgery as the preferred preventive strategy against neoplastic progression to high-grade dysplasia or esophageal adenocarcinoma, it makes no formal recommendations for or against evolving techniques such as wide-area transepithelial sampling, p53 assessment, or Tissue Cypher testing. The updated document acknowledges the limitations and information gaps in the existing literature while highlighting ongoing studies that may overcome these limitations.
“We believe these are exciting technologies that will, in the future, significantly impact how we manage patients with Barrett's esophagus,” said co-author Perica Davitkov, MD. “Our guideline provides, for the first time, direction on how these tools might be applied in both community and academic centers. Several ongoing high-quality studies will further define the role of these advanced techniques in risk stratification and in detecting Barrett’s-related neoplasia.”
According to the guideline authors, patients with Barrett’s esophagus–related dysplasia or carcinoma should be referred to specialized centers for management. The panel does not anticipate any impacts on cost or access because chromoendoscopy and PPIs are already prevalent in modern endoscopic systems. However, the panel stresses the importance of training and implementation strategies to ensure that their updated recommendations can be realized in practice.
This document represents the second installment in a three-part AGA guideline series on Barrett’s esophagus, following the 2024 publication on endoscopic eradication therapy. A third installment, addressing screening strategies, is expected in 2026.
Disclosure: For full disclosures of the study authors, visit gastrojournal.org.
