Navigating Endoscopic Surveillance and Management of Barrett's Esophagus in Elderly Patients: Balancing the Risks and Benefits.

Q1 Medicine

Current Gastroenterology Reports Pub Date : 2025-06-09 DOI:10.1007/s11894-025-00984-6

Natalie J Wilson, Cary C Cotton, Nicholas J Shaheen

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引用次数: 0

Abstract

Purpose of review: This review examines the current evidence and practical considerations for endoscopic surveillance of Barrett's esophagus (BE) in elderly patients, focusing on balancing the potential benefits and risks associated with endoscopic surveillance and eradication therapies in this population.

Recent findings: Elderly patients with BE have a higher baseline prevalence of dysplasia and esophageal adenocarcinoma (EAC). Additionally, the risk of progression from BE to EAC increases with advancing age, making surveillance particularly relevant in this population. However, recent studies suggest the benefits of surveillance decline with increasing age, greater comorbidities, and reduced life expectancy. Despite increasing awareness that ongoing surveillance endoscopy may be of minimal benefit for certain patient groups, there remains a paucity of data to guide decisions regarding discontinuation of surveillance. The management of BE in elderly patients requires a careful balance between the potential benefits of endoscopic surveillance and eradication therapies and the risks and costs associated with repeated invasive procedures. Decisions to continue endoscopic surveillance in this population should be individualized, taking into account life-expectancy and comorbidities rather than focusing solely on chronological age.

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老年患者Barrett食管导航内镜监测和管理：平衡风险和收益。

综述目的：本综述探讨了老年患者内镜下监测巴雷特食管（BE）的现有证据和实际考虑，重点是在该人群中平衡内镜下监测和根除治疗相关的潜在益处和风险。最近发现：老年BE患者有较高的不典型增生和食管腺癌（EAC）的基线患病率。此外，随着年龄的增长，从BE发展为EAC的风险也在增加，因此对这一人群进行监测尤为重要。然而，最近的研究表明，监测的好处随着年龄的增长、合并症的增加和预期寿命的缩短而下降。尽管越来越多的人意识到持续监测内窥镜对某些患者群体的益处可能微乎其微，但仍然缺乏数据来指导有关停止监测的决策。老年BE患者的管理需要在内镜监测和根除治疗的潜在益处与重复侵入性手术相关的风险和成本之间取得仔细的平衡。在这一人群中继续内镜监测的决定应个体化，考虑预期寿命和合并症，而不是仅仅关注实足年龄。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Gastroenterology Reports Medicine-Gastroenterology

CiteScore

7.80

自引率

0.00%

发文量

期刊介绍： As the field of gastroenterology and hepatology rapidly evolves, the wealth of published literature can be overwhelming. The aim of the journal is to help readers stay abreast of such advances by offering authoritative, systematic reviews by leading experts. We accomplish this aim by appointing Section Editors who invite international experts to contribute review articles that highlight recent developments and important papers published in the past year. Major topics in gastroenterology are covered, including pediatric gastroenterology, neuromuscular disorders, infections, nutrition, and inflammatory bowel disease. These reviews provide clear, insightful summaries of expert perspectives relevant to clinical practice. An Editorial Board of internationally diverse members suggests topics of special interest to their country/region and ensures that topics are current and include emerging research. We also provide commentaries from well-known figures in the field.