Australian clinical practice guidelines for the diagnosis and management of Barrett's esophagus and early esophageal adenocarcinoma

Abstract

Barrett's esophagus (BE), a common condition, is the only known precursor to esophageal adenocarcinoma (EAC). There is uncertainty about the best way to manage BE as most people with BE never develop EAC and most patients diagnosed with EAC have no preceding diagnosis of BE. Moreover, there have been recent advances in knowledge and practice about the management of BE and early EAC. To aid clinical decision making in this rapidly moving field, Cancer Council Australia convened an expert working party to identify pertinent clinical questions. The questions covered a wide range of topics including endoscopic and histological definitions of BE and early EAC; prevalence, incidence, natural history, and risk factors for BE; and methods for managing BE and early EAC. The latter considered modification of lifestyle factors; screening and surveillance strategies; and medical, endoscopic, and surgical interventions. To answer each question, the working party systematically reviewed the literature and developed a set of recommendations through consensus. Evidence underpinning each recommendation was rated according to quality and applicability.

Long-term outcomes of a primary complete endoscopic resection strategy for short-segment Barrett’s esophagus with high-grade dysplasia and/or early esophageal adenocarcinoma

“…Several guidelines recommend ER of all visible abnormalities. 5,14 Treatment of the residual BE segment is also strongly advocated because of the risk of metachronous neoplasia. This is believed to be approximately 20% to 30% in the 5 years after focal ER.…”

“…[10][11][12][13] CER studies with short-to medium-term follow-up have shown encouraging results; however, the long-term results of this approach are still to be determined. 14 Given that the optimal treatment of HGD/EEA is still evolving, the aim of this study was to evaluate the long-term outcomes of a primary CER strategy for BE with HGD/EEA.…”

Low Risk of High-Grade Dysplasia or Esophageal Adenocarcinoma Among Patients With Barrett's Esophagus Less Than 1 cm (Irregular Z Line) Within 5 Years of Index Endoscopy

“…4,5 In contrast, the most recent American Gastroenterological Association and Australian clinical practice guidelines define BE as any length of columnar mucosa in the distal esophagus with specialized IM. 6,7 This adds to the clinical conundrum in the management of patients with very short segments of columnar mucosa in distal esophagus (<1 cm) containing IM.…”

“…Since then, various definitions for BE have been proposed by different professional societies. [4][5][6][7] As per the latest American College of Gastroenterology and British Society of Gastroenterology guidelines, BE is diagnosed when columnar mucosa extends at least 1 cm proximal to gastroesophageal junction (GEJ). 4,5 In contrast, the most recent American Gastroenterological Association and Australian clinical practice guidelines define BE as any length of columnar mucosa in the distal esophagus with specialized IM.…”

Clinical significance and management of Barrett’s esophagus with epithelial changes indefinite for dysplasia

“…Repeat EGD and biopsy to clarify dysplasia status Australian Guidelines [20] Confirm by a second pathologist, ideally an expert gastrointestinal pathologist.…”