Screening

​ There are no recommended screening guidelines for esophageal cancer.

Barrett’s esophagus:

  • 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 (e.g. 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