Indications for endoscopic therapy in patients with Barrett's oesophagus include:
- High-grade dysplasia: Offer endoscopic resection of visible oesophageal lesions as first-line treatment, followed by endoscopic ablation of any residual Barrett's oesophagus after resection.
- Low-grade dysplasia: Offer radiofrequency ablation to people with low-grade oesophageal dysplasia confirmed by biopsies taken at 2 separate endoscopies, with histological diagnosis confirmed by two gastrointestinal pathologists.
- Stage 1 oesophageal adenocarcinoma (T1a): Offer endoscopic resection as first-line treatment, followed by endoscopic ablation of any residual Barrett's oesophagus after resection.
- Indefinite dysplasia: Consider endoscopic surveillance at 6-monthly intervals with dose optimisation of acid-suppressant medication rather than immediate endoscopic therapy.
Endoscopic therapy is not indicated for Barrett's oesophagus without dysplasia or for short-segment Barrett's oesophagus without intestinal metaplasia after confirmation by two endoscopies.
Endoscopic resection is also used for staging in suspected stage 1 oesophageal adenocarcinoma.
Endoscopic follow-up is recommended after endoscopic treatment for Barrett's oesophagus with dysplasia or stage 1 adenocarcinoma.
Oesophagectomy is considered for T1b oesophageal adenocarcinoma or if there is incomplete endoscopic resection or evidence of lymphovascular invasion or deep submucosal invasion.
Anti-reflux surgery is not recommended to prevent progression to dysplasia or cancer in Barrett's oesophagus.
References: NICE NG231