Resources

Diagnosis

Diagnostic Criteria

  1. BE diagnosis requires finding intesitnal metaplasia in tubular esophagus
  2. BE should be diagnosed when:
    1. ENDOSCOPIC: there is extension of salmon-colored mucosa into the tubular esophagus, extending ≥1 cm proximal to the top of gastric folds
    2. HISTOLOGIC: with biopsy confirmation of intestinal metaplasia

Screening

When NOT to

  1. Endoscopic biopsy should not be performed in the presence of a normal Z line or a Z line with <1 cm of variability (strong recommendation, low level of evidence).
  2. Screening of the general population is not recommended (conditional recommendation, low level of evidence)
  3. Before screening is performed, consider
    1. the overall life expectancy of the patient
    2. and subsequent implications, such as the need for periodic endoscopic surveillance and therapy, if BE with dysplasia is diagnosed, should be discussed with the patient
  4. If initial endoscopic evaluation is negative for BE, repeating endoscopic evaluation for the presence of BE is not recommended. If endoscopy reveals esophagitis (Los Angeles Classification B, C, D), repeat endoscopic assessment after PPI therapy for 8-12 weeks is recommended to ensure healing of esophagitis and exclude the presence of underlying BE of (conditional recommendation, low level of evidence).

Risk Factors

  1. Screening for BE may be considered
    1. with chronic (weekly for 5 or more years symptoms of gastroesophageal reflux (heartburn or acid regurgitation)
    2. AND three or more risk factors for BE or EAC including:
      1. male sex
      2. age >50 years,
      3. Caucasian race,
      4. presence of central obesity (waist circumference >102cm or waist-hip ratio (WHR) >0.9),
      5. current or past history of smoking,
      6. and a confirmed family history of BE or EAC (in a first-degree relative)
      7. strength of recommendation: conditional; quality of evidence: very low

Alternatives

  1. ASGE 2016: Unsedated transnasal endoscopy (uTNE) can be considered as an alternative to conventional upper endoscopy for BE screening (strong recommendation, low level of evidence).
  2. swallowable, nonendoscopic capsule device combined with a biomarker is an acceptable alternative to endoscopy for screening for BE

Surveillance

Diagnosis/Assessment/Staging

Endoscopy