So far, regression of low-grade dysplasia has occurred in 66% of the patients. Dr. Canto pointed out that 53% of the incident high-grade dysplasias or cancers developed after two EGDs with no dysplasia.
“What if you have the patient back at year 5 according to the AGA guidelines, but the patient developed a Barrett's cancer or high-grade dysplasia in year 2? We don't have the evidence for increasing the surveillance intervals. In fact, preliminary evidence suggests Barrett's high-grade dysplasia or cancer might be missed if you followed the AGA guidelines.”
Screening for Barrett's esophagus and associated neoplasia presents another quagmire. ACG guidelines state that patients with chronic GERD symptoms are most likely to have Barrett's esophagus and should undergo upper endoscopy, but an AGA technical review concluded there is no direct evidence that has validated screening for esophageal cancer in the United States. This is in part because 40% of Barrett's patients with cancer have no GERD symptoms and fewer than 4% have Barrett's diagnosed before the cancer is diagnosed.
Endoscopic tools for screening include a standard videoendoscope (sedated or unsedated), an unsedated thin videoendoscope, an office-based thin battery-powered endoscope, and wireless capsule endoscopy.
Patients with low-grade dysplasia, shown here, need an EGD every 6 months for a year. Courtesy Dr. Marcia Irene Canto