Guideline to Practice: Diagnosis and Management of Barrett's Esophagus: An Updated ACG Guideline

Implementation of information in guidelines can be fraught with difficulty.Although guideline recommendations generally provide straightforward pronouncements, given the complexities of patient care, in practice, implementing recommendations can be difficult.The purpose of this work was to demonstrate implementation of information in "Diagnosis and Management of Barrett's Esophagus: An Updated ACG Guideline" (1).Below, we present 3 clinical vignettes that demonstrate the application of guidance to the bedside in commonly encountered situations. VIGNETTE 1A 55-year-old White man is referred by his primary care physician for an esophagogastroduodenoscopy (EGD) for screening for Barrett's esophagus (BE).The patient has a long history of proton pump inhibitor (PPI) use for daily heartburn and regurgitation, well controlled on omeprazole 20 mg daily.Of note, the patient smokes 1 pack of cigarettes daily.On physical examination, he has a body mass index of 35.At the time of EGD, the esophageal landmarks are noted: diaphragmatic pinch at 40 cm, top of the gastric folds at 40 cm, and an irregular Z line at 40 cm (Figure 1).The remainder of the EGD was unremarkable.Per your routine practice, biopsies were obtained from