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Diagnosis and Management of Barrett’s Esophagus. ACG guideline, 2022

AGA Clinical Practice Guideline on Endoscopic Eradication Therapy of Barrett’s Esophagus and Related Neoplasia, 2024

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Flowcharts

Diagnosis of Barrett’s Esophagus
Management of Barrett’s Esophagus related neoplasm

Screening for BE

The patient should have screening for BE with

Chronic GERD Symptoms
- Weekly symptoms persisting for 5 or more years
≥ 3 Additional Risk Factors
- Greater than 50 years old
- Males
- Obesity
- Family history of BE or esophageal adenocarcinoma (EAC)
- Active smokers or with a history of smoking
- White people
- Each Additional Risk Factor Increases the prevalence of BE by 1.2%
If the screening at the first time is negative, it's not recommended for repeat surveillance.
We recommend both white light endoscopy and chromoendoscopy in patients undergoing endoscopic surveillance of BE
We recommend a structured biopsy protocol be applied to minimize detection bias in patients undergoing endoscopic surveillance of BE

Diagnosis of BE

Presence of Columnar mucosa

The present of intestinal metaplasia(IM) or not from pathology to made diagnosis still Controversial

ACG suggest that a diagnosis of BE require the finding of intestinal metaplasia (IM) in the tubular esophagus (conditional recommendation, very-low-quality evidence)

Columnar mucosa include three types: gastric fundic type, junctional cardiac type, intestinal type

Pathological type	Guidelines	Explanation
With IM, goblet cells in biopsy samples	Most guidelines
Northern Ireland Cancer Registry show HR=3.54 in patient with IM comparing with those without IM developing EAC
Without IM, goblet cells are not present.	British Society of Gastroenterology and the Asia Pacific region	Several UK studies and other data show no significant in patient with/without IM developing EAC

Columnar Mucosa Length

Prague criteria for diagnosing Barrett’s Esophagus (BE), emphasizing a 1-cm threshold for the extent of columnar epithelium.