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

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Introduction

Cancer of the upper gastrointestinal (UGI) tract may develop in association with several underlying diseases. Surveillance of premalignant UGI conditions refers to endoscopic follow-up of individuals who are at increased risk for malignancy or in whom a neoplastic lesion has been identified and removed. The natural history of many of these premalignant conditions is not well characterized, and published surveillance data are limited by both lead-time and length-time bias. This guideline addresses the following conditions: Barrett's esophagus, achalasia, caustic ingestion, tylosis, upper aerodigestive tract cancer, gastric epithelial polyps, intestinal metaplasia of the stomach, pernicious anemia, postgastrectomy, familial adenomatous polyposis, and hereditary nonpolyposis colorectal cancer syndrome. This review updates the 1998 ASGE guideline on this subject.1

Section snippets

Barrett's esophagus

Barrett's esophagus is defined as specialized intestinal metaplasia of the distal tubular esophagus irrespective of length.2 The recognition of Barrett's esophagus as the premalignant precursor to adenocarcinoma has led to societal statements and recommendations regarding surveillance endoscopy.1, 3, 4 Controversy exists, however, regarding the clinical efficacy of both screening and surveillance, as evidenced by a recent workshop of recognized experts in Barrett's esophagus.5 Retrospective

Gastric epithelial polyps

The majority of gastric epithelial polyps found during endoscopy are incidental and frequently either of hyperplastic or fundic gland histology (70%-90%).1 These polyps, in particular fundic gland polyps, were thought to be of no malignant potential. Fundic gland polyps may develop in association with long-term proton pump inhibitor use but have not been associated with an increased risk of cancer.74 Adenomatous polyps have malignant potential, and this risk correlates with size and older

Familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer

Upper gastrointestinal polyps are common in individuals with familial adenomatous polyposis (FAP).127, 128, 129, 130, 131, 132, 133, 134, 135, 136, 137 Gastric polyps are most often fundic gland polyps (FGPs) and are found in up to 88% of children and adults with FAP.129, 138 Dysplasia is found in FGPs in 45% of adults and 31% of children at a mean of 14.4 years.138 The malignant potential of dysplastic FGP appears negligible given the high prevalence of disease; however, cases of gastric

Summary

  • 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 (C).

  • 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).

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