The American Gastroenterological Association (AGA) has released updated practice guidance on Barrett’s esophagus (BE) surveillance, marking its first comprehensive update on post-diagnosis monitoring since 2011.
Published in Gastroenterology, the guideline introduces eight evidence-based recommendations that shift BE surveillance away from a one-size-fits-all model toward a more individualized, risk-based approach. Notably, BE segment length is now recommended as a key determinant for guiding endoscopic surveillance intervals, while routine surveillance is no longer advised for patients with columnar-lined esophagus measuring less than 1 cm in the absence of dysplasia or visible lesions.
The guidance also underscores the importance of reassessing surveillance based on age, comorbidities, and overall benefit, and recommends daily proton pump inhibitor therapy as the preferred preventive strategy over anti-reflux surgery.
Although emerging tools such as biomarkers (e.g., p53, TissueCypher) and enhanced sampling techniques were acknowledged as promising risk-stratification strategies, the panel stopped short of recommending for or against their routine use pending further evidence. The role of AI in improving dysplasia detection was similarly highlighted as an area requiring validation through randomized trials.
Together, the recommendations aim to improve early detection of Barrett’s-related neoplasia while minimizing unnecessary procedures—an increasingly important balance as BE surveillance practices continue to evolve.