British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus

Abstract

These guidelines provide a practical and evidence-based resource for the management of patients with Barrett's oesophagus and related early neoplasia. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was followed to provide a methodological strategy for the guideline development. A systematic review of the literature was performed for English language articles published up until December 2012 in order to address controversial issues in Barrett's oesophagus including definition, screening and diagnosis, surveillance, pathological grading for dysplasia, management of dysplasia, and early cancer including training requirements. The rigour and quality of the studies was evaluated using the SIGN checklist system. Recommendations on each topic were scored by each author using a five-tier system (A+, strong agreement, to D+, strongly disagree). Statements that failed to reach substantial agreement among authors, defined as >80% agreement (A or A+), were revisited and modified until substantial agreement (>80%) was reached. In formulating these guidelines, we took into consideration benefits and risks for the population and national health system, as well as patient perspectives. For the first time, we have suggested stratification of patients according to their estimated cancer risk based on clinical and histopathological criteria. In order to improve communication between clinicians, we recommend the use of minimum datasets for reporting endoscopic and pathological findings. We advocate endoscopic therapy for high-grade dysplasia and early cancer, which should be performed in high-volume centres. We hope that these guidelines will standardise and improve management for patients with Barrett's oesophagus and related neoplasia. PURPOSE AND METHODSThe purpose of this guideline is to provide a practical and evidence-based resource for the management of patients with Barrett's oesophagus and related early neoplasia. This document is therefore aimed at gastroenterologists, physicians and nurse practitioners, as well as members of multidisciplinary teams (MDTs; surgeons, radiologists, pathologists), who take decisions on the management of such patients. The population covered by these guidelines includes: patients with gastrooesophageal reflux disease or other risk factors for Barrett's (obesity, family history for Barrett's and oesophageal adenocarcinoma (OAC)); every patient with incident or prevalent Barrett's oesophagus regardless of their age, sex or comorbidities; patients with early OAC and patients with intestinal metaplasia (IM) at the gastro-oesophageal junction (GOJ) with no endoscopic evidence of Barrett's oesophagus. The previous British Society of Gastroenterology (BSG) development of the guidelines and to aid assessment of the quality of the guidelines. Three appraisers in the author list assessed the compliance of the guidelines to the AGREE II domains. As part of the AGREE II criteria, external review of this manuscript was also performed by two internationally renowne...

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

“…Th e presence of IM has traditionally been a requirement for the diagnosis of BE in the United States. On the other hand, guidelines from the United Kingdom have considered BE to be present if there was visual evidence of columnar-lined epithelium (CLE) on endoscopic examination and biopsies demonstrated columnar metaplasia, regardless of the presence of IM ( 10 ). Th e debate regarding the requirement of IM on biopsy from CLE segments has derived from the apparently diff erential risk of developing EAC in CLE containing IM compared with non-IM CLE.…”

“…Th e recent British Society of Gastroenterology guideline statement recommends, based on expert opinion, a minimum of 30 supervised endoscopic resections and 30 ablations for competence ( 10 ). For radiofrequency ablation, a single endoscopist case series demonstrated no diff erence in eradication of IM, complications, and procedure time in the initial 25% vs. later 75% of cases and the initial 50% vs. later 50% of cases ( 193 ).…”

Risk stratifying the screening of Barrett's esophagus: An Asian perspective

“…Analysis of demographics and symptoms was performed in relation to the gold standard of histology 2, 3…”

Reflux characteristics of 113 GERD patients with abnormal 24-h multichannel intraluminal impedance-pH tests

“…Aging is one of the risk factors for GERD and its complications (El-Serag et al, 2009;Fitzgerald et al, 2014). When GERD patients were subdivided into four groups according their ages, there were no significant differences among the four groups for reflux parameters.…”

“…At present, proton pump inhibitors (PPIs) are the first-line medication for the treatment of GERD. However, this treatment may not be suitable for some symptoms of GERD patients, and it has uncertain effect in preventing Barrett's esophagus (BE), intestinal metaplasia (IM) and adenocarcinoma (American Gastroenterological Association, 2011;Fitzgerald et al, 2014). GERD patients with different symptoms may have different reflux profiles and should be given different treatments.…”