National and international recommendations on screening for esophageal adenocarcinoma, Barrett esophagus or dysplasia
| Guideline group | Recommendations |
|---|---|
| Canadian Task Force for Preventive Health Care, 2020 | The task force recommends not screening adults with chronic GERD for esophageal adenocarcinoma or precursor conditions (Barrett esophagus or dysplasia) (strong recommendation; very low-certainty evidence). |
| Benign Barrett’s and CAncer Taskforce “BoB CAT” consensus group,* 201520 | This guideline suggests against screening the general population for Barrett esophagus endoscopically or with nonendoscopic methods (conditional recommendation, low-quality evidence). |
| American College of Gastroenterology, 20155 | Screening of the general population is not recommended (conditional recommendation, low level of evidence). Screening for Barrett esophagus may be considered in men with chronic (> 5 yr) or frequent (weekly or more) symptoms of gastroesophageal reflux disease and 2 or more risk factors for Barrett esophagus or esophageal adenocarcinoma† (strong recommendation, moderate level of evidence). Screening for Barrett esophagus in women is not recommended. However, screening could be considered in individual cases as determined by the presence of multiple risk factors for Barrett esophagus or esophageal adenocarcinoma‡ (strong recommendation, low level of evidence). |
| American Society for Gastrointestinal Endoscopy, 201562 | This guideline recommends esophagogastroduodenoscopy for patients who have symptoms suggesting complicated gastroesophageal reflux disease or alarm symptoms§ (moderate-quality evidence). The guideline suggests that endoscopy be considered in patients with multiple risk factors¶ for Barrett esophagus (very low-quality evidence). |
| National Institute for Health Care Excellence, 201461 | Endoscopy should not routinely be offered to diagnose Barrett esophagus, but considered if the person has gastroesophageal reflux disease. The recommendation is to discuss the person’s preferences and their individual risk factors (for example, long duration of symptoms, increased frequency of symptoms, previous esophagitis, previous hiatus hernia, esophageal stricture or esophageal ulcers, or male gender). |
| British Society of Gastroenterology, 20134 | Screening with endoscopy is not feasible or justified for an unselected population with gastroesophageal reflux symptoms (recommendation grade B). Endoscopic screening can be considered in patients with chronic gastroesophageal reflux disease symptoms and multiple risk factors (at least 3 of the following: age = 50 yr, white race, male sex, obesity). However, the threshold of multiple risk factors should be lowered in the presence of family history including at least 1 first-degree relative with Barrett or esophageal adenocarcinoma (recommendation grade C). |
| American Gastroenterological Association, 201160 | The guideline recommends against screening the general population with gastroesophageal reflux disease for Barrett esophagus (strong recommendation, low-quality evidence). In patients with multiple risk factors associated with esophageal adenocarcinoma (age = 50 yr, male sex, white race, chronic gastroesophageal reflux disease, hiatal hernia, elevated BMI and intra-abdominal distribution of body fat), the guideline suggests screening for Barrett esophagus (weak recommendation, moderate-quality evidence). |
| Canadian Association of Gastroenterology, 200459 | Endoscopic screening for Barrett esophagus in patients with long-standing gastroesophageal reflux disease has not been shown to reduce mortality from esophageal adenocarcinoma (level III evidence, recommendation grade C). |
Note: BMI = body mass index, GERD = gastroesophageal reflux disease, WHR = waist–hip ratio.
↵* International systematic evidence base group endorsed by International Society of Diseases of the Esophagus, Esophageal Charity Fund of Ireland, Fight Esophageal Reflux Together, Association of Upper GI Surgeons, British Society of Gastroenterology, German Gastroenterology Society, American Gastroenterology Association, American College of Gastroenterology, International Working Group for Columnar Esophagus, European Society of Thoracic Surgeons (www.isde.net/bobcat).
↵† These risk factors include age > 50 years, white race, presence of central obesity (waist circumference > 102 cm or WHR > 0.9), current or history of smoking, and a confirmed family history of Barrett esophagus or esophageal adenocarcinoma (in a first-degree relative).
↵‡ Risk factors include age > 50 years, white race, chronic or frequent gastroesophageal reflux disease, central obesity: waist circumference > 88 cm, WHR > 0.8, current or history of smoking, and a confirmed family history of Barrett esophagus or esophageal adenocarcinoma (in a first-degree relative)) (strong recommendation, low level of evidence).
↵§ Alarm symptoms: Dysphagia, odynophagia, weight loss, bleeding or anemia.
↵¶ Risk factors include white race, male sex, older age (> 50 years of age), prolonged gastroesophageal reflux disease symptoms (> 5 years), a family history of Barrett esophagus or adenocarcinoma of the esophagus, nocturnal reflux symptoms, hiatal hernia, increased BMI (≥ 25 kg/m2), tobacco use and intra-abdominal distribution of fat.