Management Strategies for Barrett’s Esophagus

Surveillance

In the practice of surveillance, the physician performs an endoscopy and takes samples of the suspected Barrett’s tissue. Physicians are encouraged to use the “Seattle Protocol”, which requires biopsy samples every 1 cm to 2 cm in 4 quadrants. So if there was a 4 cm section of Barrett’s, that would be up to 16 biopsies.

The length of time between surveillance procedures varies, and is largely up to the physician. The AGA suggests surveillance intervals for dysplasia should take place at 3, 6 and 12 months, depending on the severity of the Barrett’s. Surveillance for non-dysplasia is recommended every 3 to 5 years. Patient compliance is a major factor in surveillance intervals. When something doesn’t hurt or bother you, it’s easy to “forget” your next endoscopy.

There are some limitations to a managing Barrett’s with surveillance. The technique only monitors the Barrett’s, looking for progression to a more severe grade. This has been called out as a contributing factor to patient anxiety. Imagine having a pre-cancerous lesion managed by a biopsy every 3-5 years.

 

Next Page: Biopsy

The options for management and eradication of Barrett’s have evolved over the years, and physician practice habits are changing as more options become available.