Clinical significance and management of Barrett’s esophagus with epithelial changes indefinite for dysplasia

Table 4 Guideline recommendations for the management of Barrett’s esophagus with epithelial change indefinite for dysplasia

Guidelines	Diagnosis	Treatment and surveillance
ACG guidelines[1]		Acid suppressive medications for 3-6 mo A repeat endoscopy after optimization of should be performed If BE IND, surveillance in 12 mo
BSG guidelines[18]	Review by a second GI pathologist, and the reasons for use of the ‘indefinite for dysplasia’ category should be given in the histology report in order to aid patient management	Optimisation of antireflux medication Repeat endoscopy in 6 mo If no dysplasia is found, then the surveillance per non-dysplastic Barrett’s oesophagus
ASGE[19]	Clarify presence and grade of dysplasia with expert GI pathologist	Increase antisecretory therapy to eliminate esophageal inflammation. Repeat EGD and biopsy to clarify dysplasia status
Australian Guidelines[20]	Confirm by a second pathologist, ideally an expert gastrointestinal pathologist.	Repeat endoscopy in 6 mo with Seattle protocol biopsies for suspected dysplasia (biopsy of any mucosal irregularity and quadrantic biopsies every 1 cm) on maximal acid suppression If repeat shows no dysplasia, then follow as per non-dysplastic protocol If repeat shows low-grade or high-grade dysplasia or adenocarcinoma, then follow protocols for these respective conditions If repeat again shows confirmed indefinite for dysplasia, then repeat endoscopy in 6 mo with Seattle protocol biopsies for suspected dysplasia

BE IND: Barrett’s esophagus with epithelial change indefinite for dysplasia.