This article is more than 5 years old. Information may no longer be current.
ACG recommends changes in screening, surveillance, treatment for Barrett's esophagus
Click Here to Manage Email Alerts
The ACG has released an updated guideline for diagnosing and managing patients with Barrett’s esophagus, which recommends expanded use of endoscopic ablative therapy and changes to previous screening and surveillance recommendations.
“These guidelines differ markedly from their predecessor in several areas,” Nicholas J. Shaheen, MD, MPH, FACG, from the division of gastroenterology and hepatology at University of North Carolina at Chapel Hill, and colleagues wrote.
Nicholas J. Shaheen
Screening, surveillance
The guideline provides new screening recommendations, updated in part based on evidence showing patients with nondysplastic BE have a lower risk of esophageal adenocarcinoma (EAC).
While the guideline continues to recommend screening for BE in high-risk patients, routine screening is recommended only in men with chronic GERD symptoms and at least two risk factors for BE or EAC.
Moreover, “the most important of these changes” is that routine BE screening in women with GERD symptoms is no longer recommended. This updated recommendation is based on evidence showing that “women (even those with daily or weekly reflux symptoms) have a low incidence of EAC comparable to that of men without reflux symptoms.”
Finally, the guideline reduced recommended endoscopic surveillance intervals to every 3 to 5 years for BE patients without dysplasia based on “the relatively rare occurrence of progression in nondysplastic BE, as well as the unclear nature of benefit inherent in endoscopic surveillance.”
Routine use of biomarkers or advanced endoscopic imaging techniques other than high-definition endoscopy are not currently recommended for surveillance based on available evidence.
Therapy
“No aspect of these guidelines has evolved more since the last guideline iteration than therapeutic aspects of BE,” the authors wrote.
One of the guideline’s major changes is the recommendation to expand the use of endoscopic ablative therapy, particularly in patients with low-grade dysplasia (LGD).
“Recent data demonstrate that in patients with BE and LGD confirmed by a second pathologist, ablative therapy results in a statistically and clinically significant reduction in progression to the combined endpoint of [high-grade dysplasia] or EAC, or to EAC alone,” the authors wrote. However, endoscopic surveillance every 12 months continues to be an alternative in this population.
Endoscopic ablative therapy is also recommended for patients with BE and confirmed high-grade dysplasia without life-limiting comorbidity, and also for patients with T1a EAC. Moreover, postablation endoscopic surveillance intervals are suggested considering the relatively common recurrence of BE after ablation.
Developments on the horizon
Technological advancements in the near future are likely to cause paradigm shifts in several key areas, including biomarkers for risk stratification, advanced imaging and biomolecular technologies for recognition of neoplasia, and less invasive, lower-cost screening methods, the authors wrote. “All of these areas offer the promise of improved care at reduced costs. Although the time horizon of these developments is unpredictable, it is likely that advances in one or more of these areas will cause marked changes in the next iteration of these guidelines.” – by Adam Leitenberger
Disclosures: Shaheen reports he receives research funding from Covidien, CSA Medical, NeoGenomics, GI Dynamics, Takeda Pharmaceuticals and CDx Diagnostics. Please see the full guideline for a list of all other authors’ relevant financial disclosures.
Click Here to Manage Email Alerts