Primary Motility  Disorders of the  Esophagus
 The Esophageal
 Esophagogastric  Junction

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Volume: Barrett's Esophagus
Chapter: Screening and surveillance

Can surveillance intervals be defined?

D. Lieberman (Portland)

In order to define appropriate intervals for surveillance of patients with Barrett's esophagus we need to know the progression rates of:
- short and long segment Barrett's esophagus;
- Barrett's esophagus with no dysplasia;
- Barrett's esophagus indefinite for dysplasia;
- Barrett's esophagus with low-grade dysplasia.

We lack complete understanding of the impact of potential risk factors on progression such as:
- gender - greater risk of Barrett's esophagus and adenocarcinoma in men;
- race and ethnicity - preponderance of cancer in Caucasians;
- duration of reflux symptoms;
- control or lack of control of reflux symptoms.

The natural history of patients with no evidence of progression over time is also unknown. For example, if patients have multiple surveillance exams which show no evidence of inflammation or progression, is it safe or reasonable to stop surveillance altogether ?

In conclusion, we have no evidence upon which to base a recommendation for surveillance intervals. Studies are needed to define the natural history of Barrett's esophagus, and identify the modulating effects of various risk factors on progression to malignancy. Clinical studies which assess the risk and benefit or different surveillance intervals are needed.

Publication date: August 2003 OESO©2015