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Barrett's esophagus: Surveillance and management

Stuart J Spechler, MD
Section Editor
Nicholas J Talley, MD, PhD
Deputy Editor
Kristen M Robson, MD, MBA, FACG


In Barrett's esophagus, metaplastic columnar epithelium replaces the stratified squamous epithelium that normally lines the distal esophagus [1,2]. The metaplastic epithelium is acquired as a consequence of chronic gastroesophageal reflux disease and predisposes to cancer development.

This topic will review the management of Barrett's esophagus, including the approach to surveillance (algorithm 1). The pathogenesis, clinical manifestations, and diagnosis of Barrett's esophagus are discussed separately. (See "Barrett's esophagus: Pathogenesis and malignant transformation" and "Barrett's esophagus: Epidemiology, clinical manifestations, and diagnosis".)

The management of Barrett's esophagus has been addressed in several societal guidelines, including a 2016 guideline from the American College of Gastroenterology [3], 2013 guideline from British Society of Gastroenterology [4], a 2012 guideline from the American Society of Gastrointestinal Endoscopy [5], and a 2011 guideline and 2016 expert review from the American Gastroenterological Association [6,7]. In addition, a consensus statement on Barrett's esophagus by an international group of experts was published in 2015 [8]. The discussion that follows is generally consistent with these guidelines. However, it should be noted that many of the issues related to the surveillance and management of Barrett's esophagus remain controversial, with considerable disagreement among experts [6,9].


Cancer incidence and mortality — Estimates of the annual cancer incidence in patients with Barrett's esophagus have ranged from 0.1 to almost 3.0 percent, with more recent studies suggesting rates closer to 0.1 to 0.4 percent per year [10-26]. Although the risk of developing esophageal cancer is increased at least 30-fold above that of the general population, the absolute risk of developing cancer for a patient with nondysplastic Barrett's esophagus is low [22]. The risk of developing cancer is higher among men, older patients, and patients with long segments of Barrett's mucosa or dysplasia [18,24,25,27-29].

Patients with Barrett's esophagus most often die from causes unrelated to esophageal cancer. This is likely because many patients with Barrett's esophagus are older, overweight, and succumb to common diseases, such as coronary artery disease, before developing esophageal adenocarcinoma. In a meta-analysis with 50 studies that included 14,109 patients, the mortality rate due to esophageal adenocarcinoma was 3.0 per 1000 person-years, whereas the mortality rate due to other causes was 37.1 per 1000 person-years [23].

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Literature review current through: Nov 2017. | This topic last updated: Jan 03, 2017.
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