Surgery versus radical endotherapies for early cancer and high grade dysplasia in Barrett's oesophagus

Green, Susi; Tawil, Ashref; Barr, Hugh; Bennett, Cathy; Bhandari, Pradeep; Caestecker, John de; Ragunath, Krish; Singh, Rajvinder; Jankowski, Janusz

doi:10.1002/14651858.cd007334.pub2

Cited by 11 publications

(6 citation statements)

References 75 publications

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“…Tumour recurrence after resection of early cancer is rare (1%). There are no reports of long-term tumour recurrence in patients who have had complete surgical resection of HGD alone, and all-cause mortality is equivalent to non-surgical treatments211 290 291 (Evidence grade III).…”

Section: Management Of Dysplasia and Early Cancermentioning

confidence: 99%

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

Fitzgerald

Pietro

Ragunath

et al. 2013

Gut

Self Cite

1,163

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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...

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Section: Management Of Dysplasia and Early Cancermentioning

confidence: 99%

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

Fitzgerald

Pietro

Ragunath

et al. 2013

Gut

Self Cite

1,163

1,318

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“…New, less invasive radiological and treatment strategies are required, but these are already being introduced, such as laparoscopic surgery for colorectal carcinoma [37] and endomucosal resection of oesophageal cancers [38]. Some of the patients undergoing screening are likely to have anxieties related to the outcomes of their yearly tests, but these are arguably balanced by the knowledge that many cancers caught early are in most cases unlikely to be fatal.…”

Section: Discussionmentioning

confidence: 99%

Improved blood tests for cancer screening: general or specific?

Cree

2011

BMC Cancer

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Diagnosis of cancer at an early stage leads to improved survival. However, most current blood tests detect single biomarkers that are of limited suitability for screening, and existing screening programmes look only for cancers of one particular type. A new approach is needed. Recent developments suggest the possibility of blood-based screening for multiple tumour types. It may be feasible to develop a high-sensitivity general screen for cancer using multiple proteins and nucleic acids present in the blood of cancer patients, based on the biological characteristics of cancer. Positive samples in the general screen would be submitted automatically for secondary screening using tests to help define the likelihood of cancer and provide some indication of its type. Only those at high risk would be referred for further clinical assessment to permit early treatment and mitigate potential overdiagnosis. While the assays required for each step exist, they have not been used in this way. Recent experience of screening for breast, cervical and ovarian cancers suggest that there is likely to be widespread acceptance of such a strategy.

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“…A Cochrane review initially conducted in 2008 and subsequently updated in 2012 found 13 published comparative studies, although there have been no published RCTs. 108,109 Two papers from the Cochrane review were not included as they dealt only with EAC and not HGD. 110,111 Patients treated surgically in these trials have generally failed endoscopic treatment due to recurrent or extensive disease and, therefore, may have more aggressive or treatment-resistant disease as compared with those who had successful endoscopic therapy.…”

Section: Comparisons Of Eet and Esophagectomymentioning

confidence: 99%

The role of esophagectomy in the management of Barrett's esophagus with high‐grade dysplasia

Badgery

Read

Winter

et al. 2020

Annals of the New York Academy of Sciences

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Barrett's esophagus (BE) with high‐grade dysplasia (HGD) has previously been a routine indication for esophagectomy. Recent advances in endoscopic therapy have resulted in a shift away from surgery. Current international guidelines recommend endoscopic therapy for BE with HGD irrespective of recurrence or progression of dysplasia. Current guidelines do not address the ongoing role of esophagectomy as an adjunct in the setting of failed endoscopic therapy. This review examines the role of esophagectomy as an adjunct to endoscopy in the management of patients with BE and HGD, with a specific focus on patients with persistent, progressive, or recurrent disease, disease resistant to endoscopic therapy, in patients with concomitant esophageal pathology, and in those patients in whom lifelong surveillance may not be possible or desired.

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Surgery versus radical endotherapies for early cancer and high grade dysplasia in Barrett's oesophagus

Cited by 11 publications

References 75 publications

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

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

Improved blood tests for cancer screening: general or specific?

The role of esophagectomy in the management of Barrett's esophagus with high‐grade dysplasia

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