New Barrett's Esophagus Guidance Emphasizes Risk Stratification

The updated practice guideline from the American Gastroenterological Association provides recommendations on surveillance and management of the condition.

Published on Feb. 24, 2026

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The recently updated practice guideline from the American Gastroenterological Association (AGA) on the surveillance of Barrett's esophagus (BE) emphasizes the need for risk stratification and high-quality endoscopic examination. The guideline provides eight main evidence-based recommendations and several key implementation statements to help monitor patients after a diagnosis of BE, a condition associated with chronic gastroesophageal reflux disease and a risk factor for esophageal adenocarcinoma.

Why it matters

The guideline is an attempt to strike a balance between desirable and undesirable effects and patient values, as several recent studies have challenged the effectiveness of endoscopic surveillance for overall or cancer-specific survival in patients with BE. The guideline moves away from a one-size-fits-all approach and emphasizes the importance of risk stratification and high-quality endoscopic examination to improve outcomes.

The details

The guideline recommends using BE length to guide endoscopic surveillance, with regular endoscopic surveillance needed in suitable patients but no surveillance recommended for patients with columnar lined esophagus less than 1 cm in the absence of any visible lesions or dysplasia. It also stresses the importance of cessation of surveillance based on age, overall health, and benefit. The guideline does not make recommendations on the use of enhanced sampling techniques or biomarkers to predict BE progression, but it recognizes their importance and notes that their role will evolve as results from ongoing trials become available.

  • The last comprehensive position paper from the AGA on BE screening, surveillance, biomarkers, and endoscopic therapy was published in 2011.
  • The guideline is the second installment in a three-part series on BE, following the 2024 guideline on endoscopic eradication therapy and with a third guideline on screening expected in 2026.

The players

Sachin Wani, MD

A professor of medicine and executive director of the Katy O. and Paul M. Rady Esophageal and Gastric Center of Excellence at the University of Colorado Anschutz Medical Campus in Aurora, Colorado, and the first author of the guideline.

Amitabh Chak, MD

The Younker-Ponsky Chair in Diagnostic Intervention at University Hospitals Cleveland Medical Center in Cleveland, who commented on the AGA guidance but was not involved in its authorship.

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What they’re saying

“This guideline is timely as the last comprehensive position paper from the AGA on BE screening, surveillance, biomarkers, and endoscopic therapy was published in 2011.”

— Sachin Wani, MD, Professor of medicine and executive director of the Katy O. and Paul M. Rady Esophageal and Gastric Center of Excellence at the University of Colorado Anschutz Medical Campus (Medscape Medical News)

“What is novel in this guideline is our move away from a one-size-fits-all approach and the need for risk stratification and for performing a high-quality endoscopic examination in patients with suspected and established BE.”

— Sachin Wani, MD, Professor of medicine and executive director of the Katy O. and Paul M. Rady Esophageal and Gastric Center of Excellence at the University of Colorado Anschutz Medical Campus (Medscape Medical News)

“It cleared up some ambiguities and addressed the use of newer methods of risk stratification.”

— Amitabh Chak, MD, Younker-Ponsky Chair in Diagnostic Intervention at University Hospitals Cleveland Medical Center (Medscape Medical News)

What’s next

The guideline recognized the importance of several risk-stratification strategies, including biomarkers and advanced sampling techniques, but did not make a recommendation for or against these strategies. The role of these approaches will undoubtedly evolve as results from several ongoing trials become available.

The takeaway

The updated AGA guideline on Barrett's esophagus surveillance emphasizes the need for risk stratification and high-quality endoscopic examination to improve outcomes, moving away from a one-size-fits-all approach. The guideline provides practical and readily implementable recommendations that align with most other US and international GI society guidelines.