Barrett's esophagus

Question 1

Recommended endoscopic screening for BE

Answer 1

Males with > 5 years GERD + one additional risk factor:

• Age >50
• Caucasian
• Central obesity
• Smoking
• Family hx of BE or EAC

Question 2

Seattle protocol

Answer 2

Surveillance OGD

4 quadrant biopsy every 2 cm along the extent of BE

Question 3

Prague criteria

Answer 3

Maximum extent (distance from OGJ to max extent of Z-line)
Circumferential extent

Question 4

Chemoprevention for BE

Rationale

Answer 4

PPI
Rationale:
-cohort studies: decrease risk of progression to neoplastic BE
-most BE patient have symptoms of GERD and endoscopic evidence of reflux esophagitis

Question 5

Risks of EAC in

1) general pop of BE
2) LGD
3) HGD

Answer 5

1) 0.25% / year
2) 0.5% / year
3) 4-8% / year

Question 6

Types of endoscopic eradication for BE

Answer 6

RFA ( most common)

Question 7

Management options for high grade syplasia/intramucosal carcinoma

Answer 7

Endoscopic ablation
Endoscopic resection
Esophagectomy
Intensive endoscopic surveillance

Question 8

Surveillance for BE controversial

1) For
2) Against

Answer 8

1) observational studies that:
- can detect curable dysplasia
- detect asymptomatic cancers at less advance stage
2) observational studies have -lead-time bias
- length-time bias
- evidence of documented incurable disease in surveillance patients