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Consensus statements developed for managing Barrett's esophagus
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An international group of experts has released a series of evidence-based consensus statements for the proper management of Barrett’s esophagus.
The project was conceived by the International Society for Diseases of the Esophagus, which, along with other organizations, funded it. Researchers formed a group of 104 experts across various specialties, and a subgroup developed 91 statements regarding the diagnosis, epidemiology, surveillance, treatment and prevention of high-grade dysplasia (HGD) and esophageal adenocarcinoma (EA) in patients with Barrett’s esophagus (BE).
“The management of [HGD] and EA of the esophagus is heterogeneous and the clinician’s perception of the available evidence is one major determinant of this variation in practice,” the researchers wrote. “However, in many cases, it is unlikely that large, well-designed randomized trials will ever be done, and in this information vacuum there is a need for an authoritative consensus on areas where there is good agreement.”
Investigators performed a systematic, evidence-based literature review of 11,904 papers across multiple disciplines in order to establish supporting evidence for the statements. Following review, four rounds of anonymous voting occurred, with responders choosing to agree strongly, agree with reservation, disagree, disagree strongly or remain undecided for each statement.
Consensus, defined as 80% of responders indicating strong or reserved agreement, was achieved for 81 of the 91 statements, including:
- “Specimens from endoscopic resection are better than biopsies for staging lesions.”
- “It is important to carefully map the size of the dysplastic areas.”
- “Patients that receive ablative or surgical therapy require endoscopic follow-up.”
- “High-resolution endoscopy is necessary for accurate diagnosis.”
- “Endoscopic therapy for HGD is preferred to surveillance.”
- “Endoscopic therapy for HGD is preferred to surgery.”
- “The combination of endoscopic resection and radiofrequency ablation is the most effective therapy.”
- “After endoscopic removal of lesions from patients with HGD, all areas of BE should be ablated.”
After voting, each statement established by the literature review was rated on a scale from very low quality to high quality. Consensus was reached on a majority of statements despite an overall low quality of related evidence: 46 statements had related evidence of very low or low quality, while 38 had moderate- or high-quality evidence.
“This work represents the most far-reaching, inclusive and informative consensus process on evaluation and management of BE with HGD/early cancer published to date,” the researchers concluded. “Most of the findings are clinically relevant and the high degree of consensus achieved for most of the questions indicates that many of the statements are appropriate for immediate use in guiding clinical activity.”
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