American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended frequency for surveillance with upper endoscopy in patients with Barrett esophagus and no dysplasia?

1. Every 1-2 years

2. Every 3-5 years

3. Every year

4. Every 6-12 months

The correct answer is: Every 3-5 years

Surveillance with upper endoscopy in patients diagnosed with Barrett esophagus and no dysplasia is recommended every 3-5 years. This interval is based on evidence indicating a lower risk of progression to esophageal cancer in patients without dysplasia. Barrett esophagus is a condition where the esophageal lining is replaced by a type of tissue that is similar to that of the intestinal lining, and while it does increase the risk of developing esophageal adenocarcinoma, the absence of dysplasia indicates that the risk of progression in a given time frame is relatively lower compared to those with dysplasia. The recommended surveillance frequency is designed to balance the need for monitoring the condition with avoiding unnecessary procedures. More frequent endoscopies, such as every year or every 6-12 months, would not offer significant benefit for patients without dysplasia, while less frequent surveillance might potentially lead to missed opportunities for intervention if dysplasia were to develop. Therefore, the recommendation of every 3-5 years is an appropriate strategy to ensure patient safety and effective monitoring.