Wilson Natalie J, Cotton Cary C, Shaheen Nicholas J
Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Curr Gastroenterol Rep. 2025 Jun 9;27(1):38. doi: 10.1007/s11894-025-00984-6.
This review examines the current evidence and practical considerations for endoscopic surveillance of Barrett's esophagus (BE) in elderly patients, focusing on balancing the potential benefits and risks associated with endoscopic surveillance and eradication therapies in this population.
Elderly patients with BE have a higher baseline prevalence of dysplasia and esophageal adenocarcinoma (EAC). Additionally, the risk of progression from BE to EAC increases with advancing age, making surveillance particularly relevant in this population. However, recent studies suggest the benefits of surveillance decline with increasing age, greater comorbidities, and reduced life expectancy. Despite increasing awareness that ongoing surveillance endoscopy may be of minimal benefit for certain patient groups, there remains a paucity of data to guide decisions regarding discontinuation of surveillance. The management of BE in elderly patients requires a careful balance between the potential benefits of endoscopic surveillance and eradication therapies and the risks and costs associated with repeated invasive procedures. Decisions to continue endoscopic surveillance in this population should be individualized, taking into account life-expectancy and comorbidities rather than focusing solely on chronological age.
本综述探讨老年患者巴雷特食管（BE）内镜监测的现有证据和实际考量因素，重点在于平衡该人群内镜监测及根除治疗的潜在益处与风险。
老年BE患者发育异常和食管腺癌（EAC）的基线患病率较高。此外，BE进展为EAC的风险随年龄增长而增加，这使得监测在该人群中尤为重要。然而，近期研究表明，随着年龄增长、合并症增多以及预期寿命缩短，监测的益处会下降。尽管越来越多的人意识到持续的监测内镜检查对某些患者群体可能益处甚微，但指导停止监测决策的数据仍然匮乏。老年患者BE的管理需要在内镜监测和根除治疗的潜在益处与重复侵入性操作相关的风险及成本之间仔细权衡。对于该人群是否继续进行内镜监测的决策应个体化，要考虑预期寿命和合并症，而非仅关注实际年龄。
