ASGE guideline: The role of endoscopy in the surveillance of premalignant conditions of the upper GI tract

Patients with chronic GERD at risk for Barrett's esophagus should be considered for endoscopic screening (B). In patients with Barrett's esophagus without dysplasia, the cost effectiveness of surveillance endoscopy is controversial. If surveillance is performed, an interval of 3 years is acceptable (). Although an increased cancer risk has not been established in patients with Barrett's esophagus and low grade dysplasia, endoscopy at 6 months and yearly thereafter should be considered (C). Patients with Barrett's esophagus with confirmed HGD should be considered for surgery or aggressive endoscopic therapy (B). Patients with HGD who elect endoscopic surveillance should be followed-up closely (ie, every 3 months) for at least 1 year. If no further HGD is confirmed, then the interval between follow-ups may be lengthened (B). There are insufficient data to recommend routine surveillance for patients with achalasia (C). Patients with a severe caustic esophageal injury should undergo surveillance every 1 to 3 years beginning 15 to 20 years after the injury (C). Patients with tylosis should undergo surveillance endoscopy every 1 to 3 years beginning at age 30 years (C). There are insufficient data to support routine endoscopic surveillance for patients with previous aerodigestive squamous cell cancer (C). Adenomatous gastric polyps should be resected because of the risk for malignant transformation (B). Adenomatous polyps may recur in synchronous and metachronous sites, and surveillance endoscopies should be performed at 3- to 5-year intervals (C). Endoscopic surveillance for gastric intestinal metaplasia has not been extensively studied in the U.S. and therefore cannot be routinely recommended (C). However, there may be a subgroup of high-risk patients who will benefit from endoscopic surveillance (B). Patients with confirmed gastric high-grade dysplasia should be considered for gastrectomy or local resection because of the high incidence of prevalent carcinoma (B). Patients with pernicious anemia may be considered for a single screening endoscopy, particularly if symptomatic, but there are insufficient data to recommend ongoing surveillance (C). There are insufficient data to support routine endoscopic surveillance in patients with previous partial gastrectomy for peptic ulcer disease (C). Patients with FAP should undergo regular surveillance endoscopy using both end-viewing and side-viewing endoscopes, starting around the time of colectomy or after age 30 years (B). Patients with HNPCC have an increased risk of gastric and small-bowel cancer (B). Surveillance should be strongly considered (C).