Barrett’s Esophagus Management in the Elderly: Principles and Best Practice

Abstract

Purpose of Review

Endoscopic screening and surveillance for Barrett’s esophagus (BE) as well as treatment of dysplastic BE is well established. A significant proportion of BE patients are older (geriatric age group, > 65 years age). There is relatively little information or recommendations in the literature with regards to evaluation and management of geriatric BE patients. The purpose of this review is to outline specific caveats and best practice recommendations to help manage the geriatric BE patient.

Recent Findings

In this review, we have attempted to summarize the latest evidence and guideline-based recommendations for evaluation and treatment of BE and early esophageal neoplasia, with a special focus on the challenges and considerations involved when caring for the geriatric BE patient. Concepts related to sedation, endoscopy, risk-benefit assessment, and other unique issues pertaining to the older BE patient are discussed. Expert recommendations are provided wherever possible.

Summary

This review highlights the importance of recognizing the unique aspects of evaluating and managing the geriatric BE patient. Practical recommendations are discussed which will help the provider individualize and optimize care for their geriatric BE patient.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Correspondence to Vivek Kaul.

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Conflict of Interest

Dr. Vivek Kaul is a consultant for Olympus, Medtronic, Cook Medical and CSA Medical, and has received research funding from CSA Medical outside of the submitted work. Sarah Enslin has no COI to report.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

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This article is part of the Topical Collection on Gastroenterology in Geriatric Patients

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Enslin, S., Kaul, V. Barrett’s Esophagus Management in the Elderly: Principles and Best Practice. Curr Gastroenterol Rep 22, 37 (2020). https://doi.org/10.1007/s11894-020-00774-2

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Keywords

  • Barretts
  • Esophageal cancer
  • Geriatric
  • Ablation
  • Endoscopic resection
  • Cryotherapy