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

Curr Gastroenterol Rep. 2020 Jun 15;22(8):37. doi: 10.1007/s11894-020-00774-2.

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. 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.

Keywords: Ablation; Barretts; Cryotherapy; Endoscopic resection; Esophageal cancer; Geriatric.

Publication types

  • Review

MeSH terms

  • Adenocarcinoma / diagnosis
  • Adenocarcinoma / etiology
  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Barrett Esophagus / complications
  • Barrett Esophagus / diagnosis*
  • Barrett Esophagus / pathology
  • Barrett Esophagus / therapy*
  • Biopsy / methods
  • Chemoprevention / methods
  • Disease Progression
  • Early Detection of Cancer
  • Esophageal Neoplasms / diagnosis
  • Esophageal Neoplasms / etiology
  • Esophagoscopy
  • Fibrinolytic Agents / adverse effects
  • Fibrinolytic Agents / therapeutic use
  • Gastrointestinal Hemorrhage / chemically induced
  • Gastrointestinal Hemorrhage / prevention & control
  • Humans
  • Mass Screening
  • Population Surveillance
  • Practice Guidelines as Topic
  • Proton Pump Inhibitors / adverse effects
  • Proton Pump Inhibitors / therapeutic use
  • Thromboembolism / complications
  • Thromboembolism / prevention & control

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Fibrinolytic Agents
  • Proton Pump Inhibitors