There are no recommended screening guidelines for esophageal cancer.
- Characterized by replacement of stratified squamous epithelium of the distal esophagus by columnar epithelium with intestinal metaplasia (on review by expert gastrointestinal pathologists)
- Risk of progression to adenocarcinoma of the esophagus depends on factors including length of Barrett’s (short vs long segment), and grade of dysplasia (low vs high-grade dysplasia).
- American Gastroenterological Association (AGA) recommends screening for Barrett's esophagus in patients with multiple risk factors associated with esophageal adenocarcinoma (age 50 years or older, male sex, white race, chronic gastro-esophageal reflux disease (GERD), hiatal hernia, elevated body mass index, or intra-abdominal distribution of body fat), but not for the general population with GERD.
- Acid-reducing agents, specifically proton-pump inhibitors, can reduce symptoms and heal endoscopic findings of erosive esophagitis, but its effect on progression to dysplasia or cancer has not been well established
- Endoscopic ablative treatment (eg. radiofrequency ablation)/mucosal resection (EMR) and surveillance recommendations depend on the presence and grade of dysplasia within the Barrett’s segment:
No dysplasia: Endoscopic treatment not recommended, and surveillance endoscopy every 3 - 5 years
Low grade dysplasia: Endoscopic treatment can be considered, and in its absence, surveillance endoscopy every 6 - 12 months
High grade dysplasia: Endoscopic ablation/esophagectomy generally recommended, and in its absence, surveillance endoscopy every 3 months