期刊
GASTROENTEROLOGY
卷 143, 期 2, 页码 336-346出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/j.gastro.2012.04.032
关键词
BADCAT; Esophageal Cancer; Treatment Strategy; Systematic Analysis
资金
- AstraZeneca
- Abbott Laboratories
- AltanaPharma
- Axcan
- Eisai Limited
- Gilead
- Janssen Ortho Inc
- Merck
- NPS Pharmaceuticals
- Nycomed
- Olympus Canada Inc
- Pentax Medical Inc
- Pfizer
- Proctor Gamble
- Schering-Plough
- Shire Canada
- Takeda Canada
- Warner-Chilcott
- XenoPort Inc.
- BARRX research grant
- Janssen Cilag France
- ADDEX
- Pentax
- Axcan Pharma
- DUSA Pharmaceuticals
- BARRX
- Olympus Keymed
- Cook Medical
- BARRX Medical
- International Society of Diseases of the Esophagus
- British Society of Gastroenterology
- American College of Gastroenterology
- American Gastroenterological Association
- American Society for Gastrointestinal Endoscopy
- Association of Upper Gastrointestinal Surgeons
- Fight Oesophageal Reflux Together
- German Society of Endoscopy
- Netherlands Association of Hepatogastroenterologists
- Oesophageal Cancer Fund of Ireland
- National Institute for Health Research [NF-SI-0611-10065] Funding Source: researchfish
BACKGROUND & AIMS: Esophageal adenocarcinoma (EA) is increasingly common among patients with Barrett's esophagus (BE). We aimed to provide consensus recommendations based on the medical literature that clinicians could use to manage patients with BE and low-grade dysplasia, high-grade dysplasia (HGD), or early-stage EA. METHODS: We performed an international, multidisciplinary, systematic, evidence-based review of different management strategies for patients with BE and dysplasia or early-stage EA. We used a Delphi process to develop consensus statements. The results of literature searches were screened using a unique, interactive, Web-based data-sifting platform; we used 11,904 papers to inform the choice of statements selected. An a priori threshold of 80% agreement was used to establish consensus for each statement. RESULTS: Eighty-one of the 91 statements achieved consensus despite generally low quality of evidence, including 8 clinical statements: (1) specimens from endoscopic resection are better than biopsies for staging lesions, (2) it is important to carefully map the size of the dysplastic areas, (3) patients that receive ablative or surgical therapy require endoscopic follow-up, (4) high-resolution endoscopy is necessary for accurate diagnosis, (5) endoscopic therapy for HGD is preferred to surveillance, (6) endoscopic therapy for HGD is preferred to surgery, (7) the combination of endoscopic resection and radiofrequency ablation is the most effective therapy, and (8) after endoscopic removal of lesions from patients with HGD, all areas of BE should be ablated. CONCLUSIONS: We developed a data-sifting platform and used the Delphi process to create evidence-based consensus statements for the management of patients with BE and early-stage EA. This approach identified important clinical features of the diseases and areas for future studies.
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