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The American Gastroenterological Association has issued a clinical practice guideline on endoscopic surveillance of Barrett's esophagus, published in Gastroenterology and led by Sachin Wani of the University of Colorado. A multidisciplinary panel applied the GRADE framework across seven clinical domains and produced eight recommendations, along with implementation statements the authors describe as integral to the recommendations rather than optional commentary. The document was funded entirely by the AGA Institute without industry support and is endorsed by the Canadian Association of Gastroenterology.
Barrett's esophagus is the only identifiable precursor to esophageal adenocarcinoma, a malignancy with a five-year survival rate near 20 percent and incidence that has risen substantially over recent decades. The panel notes that the last comprehensive AGA position paper covering screening, surveillance, biomarkers, and endoscopic therapy appeared in 2011.
The panel issued a conditional recommendation in favor of surveillance for patients with nondysplastic disease, and a conditional recommendation against endoscopic surveillance in patients with columnar-lined esophagus shorter than 1 cm. The single strong recommendation favors high-definition white light endoscopy combined with chromoendoscopy over white light endoscopy alone for neoplasia detection. Daily proton pump inhibitor therapy received a conditional recommendation both over no therapy and over antireflux surgery for prevention of progression.
On two questions the panel declined to make a recommendation. It found insufficient basis to recommend for or against enhanced sampling techniques such as wide-area transepithelial sampling, and likewise for biomarkers including p53 and TissueCypher as tools to predict progression.
The guideline also addresses when surveillance can reasonably be discontinued, framing that decision around patient age, comorbidity burden, and anticipated benefit, and it directs clinicians toward shared decision making informed by patient preferences. This document is the second in a three-part series, following the 2024 guideline on endoscopic eradication therapy, with a guideline on screening still to come.
