Skip to main content

Advertisement

Log in

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

  • Gastroenterology in Geriatrics Patients (S Chokhavatia, Section Editor)
  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Image 1
Image 2
Image 3
Image 4

Similar content being viewed by others

References

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

  1. • Shaheen NJ, Falk GW, Iyer PG, Gerson LB, American College of Gastroenterology. ACG clinical guideline: diagnosis and management of Barrett's esophagus. Am J Gastroenterol. 2016;111(1):30–50 quiz 51. (Recent ACG practice guideline, practical evidence based recommendations).

    Article  CAS  PubMed  Google Scholar 

  2. • Iyer PG, Kaul V. Barrett esophagus. Mayo Clin Proc. 2019;94(9):1888–901 (Very recent comprehensive review of BE evaluation and management).

    Article  PubMed  Google Scholar 

  3. Howlader N NA, Krapcho M, et al. SEER Cancer Statistics Review, 1975–2016, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2016/, based on November 2018 SEER data submission, posted to the SEER web site, April 2019. Accessed.

  4. Codipilly DC, Chandar AK, Singh S, Wani S, Shaheen NJ, Inadomi JM, et al. The effect of endoscopic surveillance in patients with Barrett's esophagus: a systematic review and meta-analysis. Gastroenterology. 2018;154(8):2068–86 e2065.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Coleman HG, Xie SH, Lagergren J. The epidemiology of esophageal adenocarcinoma. Gastroenterology. 2018;154(2):390–405.

    Article  PubMed  Google Scholar 

  6. Kurin M, Fass R. Management of gastroesophageal reflux disease in the elderly patient. Drugs Aging. 2019;36(12):1073–81.

    Article  PubMed  Google Scholar 

  7. Dumic I, Nordin T, Jecmenica M, et al. Gastrointestinal tract disorders in older age. Can J Gastroenterol Hepatol. 2019;2019:6757524.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Fitzgerald RC, di Pietro M, Ragunath K, Ang Y, Kang JY, Watson P, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus. Gut. 2014;63(1):7–42.

    Article  PubMed  Google Scholar 

  9. American Gastroenterological A, Spechler SJ, Sharma P, et al. American Gastroenterological Association medical position statement on the management of Barrett's esophagus. Gastroenterology. 2011;140(3):1084–91.

    Article  Google Scholar 

  10. • Qumseya B, Sultan S, ASGE SOP Committee, et al. ASGE guideline on screening and surveillance of Barrett's esophagus. Gastrointest Endosc. 2019;90(3):335–59 e332. (Very recent ASGE updated guidelines for BE manageemnt).

    Article  PubMed  Google Scholar 

  11. Ko MS, Fung KZ, Shi Y, Espaldon R, Shergill A, Walter LC. Barrett's esophagus commonly diagnosed in elderly men with limited life expectancy. J Am Geriatr Soc. 2016;64(10):e109–11.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Freedberg DE, Kim LS, Yang YX. The risks and benefits of long-term use of proton pump inhibitors: expert review and best practice advice from the American Gastroenterological Association. Gastroenterology. 2017;152(4):706–15.

    Article  CAS  PubMed  Google Scholar 

  13. Nochaiwong S, Ruengorn C, Awiphan R, Koyratkoson K, Chaisai C, Noppakun K, et al. The association between proton pump inhibitor use and the risk of adverse kidney outcomes: a systematic review and meta-analysis. Nephrol Dial Transplant. 2018;33(2):331–42.

    Article  CAS  PubMed  Google Scholar 

  14. Singh S, Garg SK, Singh PP, Iyer PG, el-Serag HB. Acid-suppressive medications and risk of oesophageal adenocarcinoma in patients with Barrett's oesophagus: a systematic review and meta-analysis. Gut. 2014;63(8):1229–37.

    Article  PubMed  Google Scholar 

  15. Bresalier RS. Chemoprevention of Barrett's esophagus and esophageal adenocarcinoma. Dig Dis Sci. 2018;63(8):2155–62.

    Article  CAS  PubMed  Google Scholar 

  16. Mittal C, Han S, Wani S. Chemoprevention of Barrett's esophagus with nonsteroidal anti-inflammatory drugs. Gastroenterology. 2017;152(6):1615–6.

    Article  PubMed  Google Scholar 

  17. Vennalaganti PR, Kaul V, Wang KK, Falk GW, Shaheen NJ, Infantolino A, et al. Increased detection of Barrett's esophagus-associated neoplasia using wide-area trans-epithelial sampling: a multicenter, prospective, randomized trial. Gastrointest Endosc. 2018;87(2):348–55.

    Article  PubMed  Google Scholar 

  18. Razavi F, Gross S, Katz S. Endoscopy in the elderly: risks, benefits, and yield of common endoscopic procedures. Clin Geriatr Med. 2014;30(1):133–47.

    Article  PubMed  Google Scholar 

  19. Trindade AJ, Navaneethan U, et al. Advances in the diagnosis and surveillance of Barrett's esophagus (with videos). Gastrointest Endosc. 2019;90(3):325–34.

    Article  PubMed  Google Scholar 

  20. Wani S, Qumseya B, ASGE SOP Committee, et al. Endoscopic eradication therapy for patients with Barrett's esophagus-associated dysplasia and intramucosal cancer. Gastrointest Endosc. 2018;87(4):907–31 e909.

    Article  PubMed  Google Scholar 

  21. Terheggen G, Horn EM, Vieth M, Gabbert H, Enderle M, Neugebauer A, et al. A randomised trial of endoscopic submucosal dissection versus endoscopic mucosal resection for early Barrett's neoplasia. Gut. 2017;66(5):783–93.

    Article  PubMed  Google Scholar 

  22. Knabe M, Blosser S, Wetzka J, et al. Non-thermal ablation of non-neoplastic Barrett's esophagus with the novel EndoRotor(R) resection device. United Eur Gastroenterol J. 2018;6(5):678–83.

    Article  Google Scholar 

  23. Shaheen NJ, Sharma P, Overholt BF, Wolfsen HC, Sampliner RE, Wang KK, et al. Radiofrequency ablation in Barrett's esophagus with dysplasia. N Engl J Med. 2009;360(22):2277–88.

    Article  CAS  PubMed  Google Scholar 

  24. Trindade AJ, Inamdar S, Kothari S, Berkowitz J, McKinley M, Kaul V. Feasibility of liquid nitrogen cryotherapy after failed radiofrequency ablation for Barrett's esophagus. Dig Endosc. 2017;29(6):680–5.

    Article  PubMed  Google Scholar 

  25. Canto MI, Shaheen NJ, Almario JA, Voltaggio L, Montgomery E, Lightdale CJ. Multifocal nitrous oxide cryoballoon ablation with or without EMR for treatment of neoplastic Barrett's esophagus (with video). Gastrointest Endosc. 2018;88(3):438–46 e432.

    Article  PubMed  Google Scholar 

  26. Solomon SS, Kothari S, Smallfield GB, Inamdar S, Stein P, Rodriguez VA, et al. Liquid nitrogen spray cryotherapy is associated with less postprocedural pain than radiofrequency ablation in Barrett's esophagus: a multicenter prospective study. J Clin Gastroenterol. 2019;53(2):e84–90.

    Article  CAS  PubMed  Google Scholar 

  27. van Munster SN, Overwater A, Haidry R, Bisschops R, Bergman JJGHM, Weusten BLAM. Focal cryoballoon versus radiofrequency ablation of dysplastic Barrett's esophagus: impact on treatment response and postprocedural pain. Gastrointest Endosc. 2018;88(5):795–803 e792.

    Article  PubMed  Google Scholar 

  28. Mohan BP, Krishnamoorthi R, Ponnada S, et al. Liquid nitrogen spray cryotherapy in treatment of Barrett's esophagus, where do we stand? A systematic review and meta-analysis. Dis Esophagus. 2019;32(6).

  29. Visrodia K, Zakko L, Singh S, Leggett CL, Iyer PG, Wang KK. Cryotherapy for persistent Barrett's esophagus after radiofrequency ablation: a systematic review and meta-analysis. Gastrointest Endosc. 2018;87(6):1396–404 e1391.

    Article  PubMed  PubMed Central  Google Scholar 

  30. • Kaul V, Bittner K, Ullah A, et al. Liquid nitrogen spray cryotherapy-based multimodal endoscopic management of dysplastic Barrett's esophagus and early esophageal neoplasia: retrospective review and long-term follow-up at an academic tertiary care referral center. Dis Esophagus. 2020; (Very recent comprehensive multimodality endoscopic BE therapy paper).

  31. Acosta RD, Abraham NS, ASGE SOP Committee, et al. The management of antithrombotic agents for patients undergoing GI endoscopy. Gastrointest Endosc. 2016;83(1):3–16.

    Article  PubMed  Google Scholar 

  32. Andreotti F, Rocca B, Husted S, Ajjan RA, ten Berg J, Cattaneo M, et al. Antithrombotic therapy in the elderly: expert position paper of the European Society of Cardiology Working Group on Thrombosis. Eur Heart J. 2015;36(46):3238–49.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Vivek Kaul.

Ethics declarations

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).

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11894-020-00774-2

Keywords

Navigation