How I Do It: Surveillance Endoscopy for Barrett’s Esophagus and Gastric Intestinal Metaplasia

Barrett’s esophagus and gastric intestinal metaplasia are precancerous conditions in the upper gastrointestinal tract that are easily identifiable on endoscopy. Although most cases will never progress to cancer, these conditions warrant endoscopic surveillance to detect and treat dysplasia. The key to detecting precancerous lesions is to follow a systematic approach for a high-quality examination. Additional steps to optimize practice are to apply image enhanced endoscopy, spend adequate time inspecting, appreciate principles of optical diagnosis, recognize mucosal and vascular patterns consistent with intestinal metaplasia and dysplasia, and take targeted biopsies of abnormalities.