Screening and surveillance of Barrett's oesophagus: what is a cost‐effective framework?

Summary There is a strong association between symptomatic gastro‐oesophageal reflux and oesophageal adenocarcinoma. With this in mind, the American College of Gastroenterology has recently revised its practice guidelines for the screening of patients with chronic gastro‐oesophageal reflux disease (GERD) to identify those at risk of oesophageal adenocarcinoma, and recommends surveillance to identify curable oesophageal neoplasms in patients with established Barrett's oesophagus. Patients  with chronic GERD symptoms, particularly those aged over 50 years, should undergo upper endoscopy. Patients  found to have Barrett's oesophagus should be treated with acid suppression for GERD symptoms and then undergo regular surveillance endoscopy. Surveillance endoscopy every 3 years is recommended for those without dysplasia. For patients with verified low‐grade dysplasia, yearly surveillance endoscopy is recommended. For those with focal high‐grade dysplasia (defined as high‐grade dysplastic changes involving fewer than five crypts), the condition may be followed with endoscopic surveillance performed at 3‐month intervals. If there is verified, multifocal high‐grade dysplasia, intervention (e.g. oesophagectomy) may be considered. Both observational and computer models suggest a benefit associated with screening and surveillance. Endoscopic screening and surveillance for Barrett's oesophagus compares favourably with mammography for the detection of breast cancer and other accepted medical practices.