ASGE Endo Hangout: Barrett's Esophagus | February 2026-Recorded Webinar

Video Transcription

Video Summary

The ASGE Endo Hangout webinar for GI fellows presented expert discussions on Barrett’s Esophagus, focusing on diagnosis, screening, surveillance, and endoscopic eradication therapy. Barrett’s Esophagus is a precursor to esophageal adenocarcinoma (EAC), a rising and deadly cancer often diagnosed late. Risk factors for Barrett’s and EAC include age >50, male sex, white race, chronic GERD, smoking, obesity, and family history. Current guidelines recommend screening patients with chronic GERD and additional risk factors, but many with EAC lack GERD symptoms, complicating screening approaches.<br /><br />New non-endoscopic screening tools like Cytosponge and EsoCheck, which collect esophageal cells via swallowable devices, are emerging to broaden and simplify screening beyond endoscopy. These devices show promise for detecting Barrett’s in primary care settings, enhancing early identification.<br /><br />Surveillance aims to detect dysplasia or early cancers, enabling minimally invasive treatments. However, challenges exist due to missed lesions, variability in pathology, and some patients developing advanced cancers despite surveillance. The BOSS trial, the largest surveillance study to date, showed no survival benefit with routine surveillance but had limitations, including study design and population differences.<br /><br />High-quality endoscopic exams adhering to strict protocols (Seattle biopsy protocol, chromoendoscopy, careful inspection including retroflexion, and lesion characterization) are vital to improving dysplasia detection. Surveillance intervals vary by Barrett’s segment length and dysplasia presence.<br /><br />Endoscopic eradication therapy (EET), including radiofrequency ablation (RFA), cryoablation, and endoscopic mucosal resection (EMR), is recommended mainly for high-grade dysplasia or early carcinoma. Success depends on expert pathology, optimized acid suppression, and multidisciplinary care. Managing complications like strictures typically involves dilation.<br /><br />The session emphasized the evolving landscape of Barrett’s management, the need for clear guidelines, risk stratification, and integration of novel screening modalities to improve early detection and outcomes in esophageal adenocarcinoma.

Keywords

Barrett's Esophagus

esophageal adenocarcinoma

GI fellows webinar

diagnosis

screening

surveillance

endoscopic eradication therapy

Cytosponge

EsoCheck

radiofrequency ablation

Seattle biopsy protocol

risk factors