This AGA expert review evaluates the appropriateness, yield, and harms of endoscopic surveillance for Barrett's esophagus and colorectal polyps/cancer in older adults (primarily those >75 years), offering best practice advice to guide shared decision-making and de-implementation of low-value surveillance.
Nine Best Practice Advice statements were issued, emphasizing individualized decision-making based on life expectancy, comorbidities, and ability to tolerate therapy; notably, inability to tolerate endoscopic, surgical, or oncologic intervention should prompt cessation of Barrett's esophagus surveillance regardless of age, and colonoscopy in older adults carries higher adverse event rates with increasing age.
No systematic review was performed, so no formal evidence ratings or strength-of-recommendation grades are assigned; real-world effectiveness and cost-effectiveness data in diverse older adult populations are lacking; evidence base for Barrett's esophagus surveillance specifically is described as more limited than for colorectal cancer surveillance.
For patients >75 years, colonoscopy and Barrett's esophagus surveillance decisions should be individualized using life expectancy tools and shared decision-making, with the rationale clearly documented in the EHR. Patients who cannot tolerate treatment for esophageal adenocarcinoma or colorectal cancer should not continue surveillance, regardless of age.
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