Barrett’s Esophagus: Endoscopic Diagnosis and Treatment
Diagnosis · Endoscopy Silo · Colombia 2026
Barrett's Esophagus: Endoscopic Diagnosis, Surveillance, and Treatment in Colombia
Barrett's esophagus is the gastroesophageal reflux complication that carries the greatest risk of esophageal adenocarcinoma—and its endoscopic surveillance with systematic biopsies and radiofrequency ablation can prevent cancer
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Medical Team at GSMED Imaging — Oncology Endoscopy Colombia
Based on: ESGE Position Statement on Barrett's Esophagus 2023, ACG Clinical Guideline Barrett's Esophagus 2024, and esophageal mucosal endoscopy practice in Colombia.
Barrett's esophagus is the condition in which the normal squamous epithelium of the distal esophagus is replaced by columnar epithelium with intestinal metaplasia—as a result of chronic damage from acid reflux. It is painless, does not cause symptoms of its own, and without an endoscopy, there is no way to know it exists. But its clinical importance is enormous: it multiplies the risk of esophageal adenocarcinoma by 30–50.
1. What Barrett's Esophagus Looks Like on Endoscopy
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Conventional White Light
Barrett's appears as salmon-colored (pink-red) mucosa ascending from the gastroesophageal junction toward the distal esophagus, in contrast with normal esophageal mucosa (pale pink-white). The extent is measured using the Prague classification (C = circumference, M = maximum extent): for example, C3M5 = circumferential Barrett's of 3 cm with a maximum extent of 5 cm.
→ Salmon color · Prague classification C and M · Visible upper limit
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NBI / Magnified Imaging (TXI, BLI)
Magnified imaging is essential for Barrett's—NBI (Olympus) or BLI (Fujifilm) reveal the vascular and glandular pattern of the mucosa, allowing differentiation between Barrett's without dysplasia and Barrett's with low-grade or high-grade dysplasia or intramucosal carcinoma—differences that are practically invisible under white light.
→ Mandatory NBI/BLI · Vascular and glandular pattern · Detects dysplasia invisible under white light
2. The Seattle Biopsy Protocol—the Standard for Barrett's Surveillance
Why the Seattle Protocol is the Global Standard for Barrett's Biopsies
The Seattle protocol takes systematic biopsies in 4 quadrants every 2 cm along the entire Barrett's segment, plus targeted biopsies of any nodular, elevated area, or area with a change in pattern. For C3M5 Barrett's, this means at least 12–16 biopsies—plus targeted ones. It is laborious and time-consuming, but it is the only validated method for detecting dysplasia that may be focally and irregularly distributed in the mucosa. ESGE 2023 recommends its systematic use in all Barrett's surveillance endoscopies.
3. Risk Staging and Management by Grade of Dysplasia
| Histological Finding | Annual Cancer Risk | Recommended Management (ESGE 2023) |
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| Barrett's without dysplasia | 0.1–0.3%/year | Endoscopic surveillance every 3–5 years · Optimize PPI |
| Barrett's with low-grade dysplasia (LGD) | 0.5–1.0%/year | Radiofrequency ablation (RFA) is the preferred option—it reduces the risk of progression by 25–30% |
| Barrett's with high-grade dysplasia (HGD) | 6–10%/year | Endoscopic mucosal resection (EMR/ESD) of visible lesions + RFA of the remaining Barrett's |
| Intramucosal adenocarcinoma | Present | En bloc EMR or ESD · If submucosal infiltration: discuss surgery vs. endoscopy with oncology |
Should all patients with gastroesophageal reflux undergo an endoscopy to look for Barrett's?
No—universal screening with endoscopy is not cost-effective in the entire population with GERD. The 2024 ACG guidelines recommend screening endoscopy for Barrett's in men over 50 years of age with GERD symptoms lasting more than 5 years plus at least 2 additional risk factors (abdominal obesity, smoking, hiatal hernia, nocturnal GERD). In women, the risk is significantly lower and the screening threshold is higher. In Colombia, the decision must be individualized with the gastroenterologist—the prevalence of esophageal adenocarcinoma is lower than in Europe and North America, although Barrett's is a common condition in the population with chronic GERD.
Systems with NBI/TXI for Barrett's Surveillance—GSMED Colombia
Olympus EVIS X1 with TXI and NBI, high-resolution gastroscopes, and systematic biopsy kits—authorized distributors in Colombia.
Related Articles
Sources
- ESGE. Barrett's Esophagus—Position Statement. esge.com. 2023. Seattle Protocol, RFA, intervals. ESGE 2023
- ACG. Clinical Guideline—Diagnosis and Management of Barrett's Esophagus. 2024. ACG 2024
