Treatment of Barrett's Esophagus with Confirmed Low-Grade Dysplasia

Barrett's esophagus with confirmed low-grade dysplasia (LGD) marks a clinically significant threshold. At this stage, the management pathway diverges, and a structured, guideline-informed approach is essential to optimise outcomes.

Clinical Scenario

This protocol addresses patients with Barrett's esophagus in whom low-grade dysplasia has been pathologically confirmed. Per current guideline recommendations, this population should engage in shared decision making regarding endoscopic eradication therapy versus continued surveillance.

Approach Overview

Management includes maximum acid suppression with a proton pump inhibitor alongside endoscopic evaluation, with attention to any visible mucosal lesions. The complete structured regimen — including sequencing, clinical decision points, and the full protocol — is available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1053/j.gastro.2025.09.012

As per the AGA Guideline on EET, patients with BE with confirmed LGD should engage in shared decision making regarding EET vs continued surveillance.
Therefore, patients should undergo repeat EGD by an expert endoscopist while on maximum acid suppression (PPI twice daily, 30–45 minutes before meals for at least 2 months) with resection of any visible lesion to rule out prevalent HGD or EAC.

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