Surveillance of Barrett's esophagus: a need for guidelines?

Barrett's esophagus carries a 10-15% lifetime risk of malignant change, and dysplasia may be an early indication of such transformation. Endoscopic surveillance is widely practised but guidelines have not been established. A questionnaire regarding surveillance protocols was sent to all consultants in the Trent Region performing endoscopy (n = 79), of whom 58 (73%) replied. Surveillance is performed by 52 clinicians (90%), but the interval varies between 1 and 3 years. Routine biopsies are only taken by 38 (65%), of which 74% are taken randomly. Detection of low-grade dysplasia would lead 32 (62%) to reduce the surveillance interval. For high-grade dysplasia, a reduced surveillance interval or surgery is advocated by 36 (69%) and 13 (25%), respectively. Most clinicians (74%) discontinue surveillance at age 70 or 75. Surveillance of Barrett's esophagus is variable, especially in the presence of dysplasia. No surveillance guidelines are available, but most respondents (79%) believe these would help.