ASGE Postgraduate Course at ACG: Evidence-based Updates for the Practicing Gastroenterologist (On-Demand) | October 2021 OLPGATACG21-The Continuum of Endoscopic Care for Barrett's Esophagus

Video Transcription

Video Summary

In this video, Dr. Pooja Elias, an associate professor at the Medical University of South Carolina, discusses the continuum of endoscopic care for Barrett's esophagus. She begins by providing an overview of Barrett's esophagus, which is the replacement of normal squamous epithelium in the esophagus with a metaplastic intestinal type epithelium. She explains that gastroesophageal reflux disease (GERD) is a known precursor to Barrett's, affecting approximately 20-30% of the U.S. population, and approximately 7-10% of GERD patients will have Barrett's. Dr. Elias emphasizes that Barrett's is the only known precursor to esophageal adenocarcinoma.<br /><br />She then discusses the importance of screening for Barrett's and highlights the risk factors, including GERD, obesity, gender, ethnicity, and family history. Dr. Elias explains the recommended screening guidelines and the diagnostic process using endoscopic biopsies, as well as various modalities for surveillance and detection of dysplasia.<br /><br />Next, she discusses the different endoscopic eradication therapies available for the treatment of dysplastic Barrett's, ranging from resection to ablative therapies. Dr. Elias stresses the importance of resecting visible lesions and achieving complete eradication of dysplasia and metaplasia.<br /><br />She also addresses controversies and challenges in the field, including alternate pathways to esophageal adenocarcinoma, the role of pH and impedance testing, the duration of post-eradication surveillance, intestinal metaplasia in the cardia, and the management of low-grade dysplasia. She mentions ongoing studies, such as the SURVENT trial, which aims to provide a definitive recommendation on the best approach for low-grade dysplasia.<br /><br />Dr. Elias concludes by discussing future directions in the field, including better screening methods, non-invasive testing, artificial intelligence, and chemoprevention. She emphasizes the need to identify the at-risk population, identify at-risk lesions early, select appropriate treatment strategies, and consider reflux testing in refractory dysplastic Barrett's.<br /><br />Overall, Dr. Elias provides an informative overview of the continuum of endoscopic care for Barrett's esophagus, highlighting the importance of early detection and treatment to prevent the progression to esophageal adenocarcinoma.

Asset Subtitle

Puja S. Elias, MD

Keywords

Barrett's esophagus

endoscopic care

GERD

screening guidelines

endoscopic eradication therapies

dysplastic Barrett's