AGA Clinical Practice Update on Surveillance of Metaplastic and Premalignant Conditions of the Esophagus and Colorectum in Older Adults: Expert Review.

Authors

Audrey H Calderwood, Cynthia M Yoshida, Koushik K Das, Gary W Falk

Published in

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. Aug 03, 2026. Epub Aug 03, 2026.

Abstract

The United States Census Bureau projects that the population of Americans ≥65 years old will grow 5 times faster than the total population, reaching 82 million by 2050 (23% of the population). Health care providers will increasingly need to discuss the cessation of cancer screening due to limited value in patients whose age or comorbidities preclude time to benefit from eradication of preneoplastic lesions. Although evidence supports colonoscopy's ability to reduce population-wide colorectal cancer mortality, high-quality data around endoscopic surveillance of Barrett's esophagus is more limited. In this Clinical Practice Update, we review practical approaches to assess appropriateness for colorectal cancer and esophageal cancer surveillance, the real-world yield of screening and/or surveillance in older adults, and the potential harms of surveillance.
This expert review was commissioned and approved by the American Gastroenterological Association Institute Clinical Practice Updates Committee and the American Gastroenterological Association Governing Board to provide timely guidance on a topic of high clinical importance to the American Gastroenterological Association membership, and underwent internal peer review by the Clinical Practice Updates Committee and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. These Best Practice Advice statements were drawn from a review of the published literature and from expert opinion. Because systematic reviews were not performed, these Best Practice Advice statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations. BEST PRACTICE ADVICE STATEMENTS BEST PRACTICE ADVICE 1: Formal determination of comorbidities and use of life expectancy tools may help differentiate among older adults most likely to benefit vs those most likely to be harmed by surveillance. Real-world effectiveness and cost-effectiveness analysis in diverse populations would help with widespread implementation. BEST PRACTICE ADVICE 2: The goal of endoscopic surveillance in Barrett's esophagus is to detect dysplasia and adenocarcinoma at an early and treatable stage. Endoscopic surveillance of Barrett's esophagus should follow current best practices in terms of imaging, tissue acquisition, and surveillance intervals. BEST PRACTICE ADVICE 3: The choice to continue endoscopic surveillance of Barrett's esophagus should be based on shared decision-making that examines factors such as comorbidities, life expectancy, risks, and benefits, as well as patient preferences. BEST PRACTICE ADVICE 4: Utilization of tools for prediction of dysplasia progression in Barrett's esophagus may help contextualize the time frame for the development of adenocarcinoma within an individual's life expectancy. BEST PRACTICE ADVICE 5: Inability to tolerate endoscopic therapy, surgery, or oncologic interventions for esophageal adenocarcinoma should lead to cessation of Barrett's esophagus surveillance regardless of age. BEST PRACTICE ADVICE 6: The decision to continue colorectal cancer screening in individuals >75 years old should be individualized, based on an assessment of benefits, screening history, comorbidities, and risks. BEST PRACTICE ADVICE 7: The decision to continue surveillance of colorectal polyps in individuals >75 years old should be individualized, based on an assessment of benefits, polyp history, comorbidities, and risks. BEST PRACTICE ADVICE 8: With increasing age, colonoscopy is associated with a higher incidence of adverse events regardless of the indication. Therefore, the clinical decision-making process for colonoscopy should be clearly documented in the electronic health record for individuals >75 years. BEST PRACTICE ADVICE 9: Whenever possible, published studies of the use, effectiveness, deimplementation, and costs of colonoscopy in older adults should be used to inform practice decisions for patients and clinicians.

PMID:
42545305
Bibliographic data and abstract were imported from PubMed on 03 Aug 2026.

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