BACKGROUND & AIMS Esophageal adenocarcinoma (EA) is increasingly common among patients with Barrett’s esophagus (BE). We aimed to provide consensus recommendations based on the medical literature that clinicians could use to manage patients with BE and low-grade dysplasia, high-grade dysplasia (HGD), or early-stage EA. METHODS We performed an international, multidisciplinary, systematic, evidence-based review of different management strategies for patients with BE and dysplasia or early-stage EA. We used a Delphi process to develop consensus statements. The results of literature searches were screened using a unique, interactive, Web-based data-sifting platform; we used 11,904 papers to inform the choice of statements selected. An a priori threshold of 80% agreement was used to establish consensus for each statement. RESULTS Eighty-one of the 91 statements achieved consensus despite generally low quality of evidence, including 8 clinical statements: (1) specimens from endoscopic resection are better than biopsies for staging lesions, (2) it is important to carefully map the size of the dysplastic areas, (3) patients that receive ablative or surgical therapy require endoscopic follow-up, (4) high-resolution endoscopy is necessary for accurate diagnosis, (5) endoscopic therapy for HGD is preferred to surveillance, (6) endoscopic therapy for HGD is preferred to surgery, (7) the combination of endoscopic resection and radiofrequency ablation is the most effective therapy, and (8) after endoscopic removal of lesions from patients with HGD, all areas of BE should be ablated. CONCLUSIONS We developed a data-sifting platform and used the Delphi process to create evidence-based consensus statements for the management of patients with BE and early-stage EA. This approach identified important clinical features of the diseases and areas for future studies.

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Helicobacter pylori colonizes the mucus layer of the human stomach and duodenum, causes chronic gastritis, gastric ulcer, and is a risk factor for gastric adenocarcinoma. There is a 20% failure rate in antibiotic therapy, which is increasingly due to antibiotic resistance and necessitates the search for alternative antimicrobial methods. We have discovered that H. pylori when cultured in liquid medium, accumulates significant quantities of coproporphyrin and protoporphyrin IX, both in the cells and secreted into the medium. These photoactive porphyrins lead to cell death (up to 5 logs) by photodynamic action upon illumination with low doses of visible light, with blue/violet light being most efficient. The degree of killing increases with the age of the culture and is greater than that found with Propionibacterium acnes (another bacterium known to be photosensitive due to porphyrin accumulation). Both virulent and drug-resistant strains are killed. The data suggest that phototherapy might be used to treat H. pylori infection in the human stomach.Helicobacter pylori is a gram-negative microaerophilic bacterium which selectively colonizes the mucus layer of the human stomach and duodenum (7). As more than 50% of the world population is infected and in some countries infection rates approach 90%, H. pylori can be termed the world's commonest infectious agent (19). H. pylori infection has been shown to be strongly associated with the presence of inflammation and chronic gastritis, and once acquired, H. pylori persists, usually for life, unless eradicated by antimicrobial therapy (15). It is now known that H. pylori is a major cause of peptic ulcer disease, and in 1994, the International Agency for Cancer Research declared that H. pylori was a carcinogen of humans and was implicated in the development of gastric cancer (11).The most common antibacterial treatment regimens include bismuth, metronidazole, tetracycline, and a proton pump inhibitor, or clarithromycin in combination with a proton pump inhibitor and amoxicillin (10). Combinations such as the above lead to eradication rates of about 80% but at the expense of side effects and possible poor patient compliance. Increasing development of antibiotic resistance among H. pylori isolates and the existence of nonresponsive patients suggest that alternative strategies for H. pylori eradication be sought (22).Photodynamic therapy uses the combination of nontoxic dyes (frequently porphyrins or their derivatives) and harmless visible light to produce cytotoxicity via generation of reactive oxygen species (25). Photodynamic therapy has been clinically approved for various malignant, premalignant, and ophthalmologic conditions (6). It has long been known that many microorganisms including gram-negative and gram-positive bacteria, mycoplasma, fungi, and viruses can be killed by photodynamic therapy, and recently photodynamic therapy has been investigated as a treatment for infectious disease (12). The grampositive bacterium that causes acne, Propionibacterium acnes, is kil...

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