Guideline Updated for Screening, Surveillance of Barrett Esophagus
WEDNESDAY, Sept. 11, 2019 -- In a guideline published in the September issue of Gastrointestinal Endoscopy, updated recommendations are presented for screening and surveillance among patients with Barrett esophagus (BE).
Bashar Qumseya, M.D., M.P.H., from the Archbold Medical Group in Thomasville, Georgia, and colleagues conducted a systematic review to offer evidence-based recommendations and clinical guidelines addressing key issues related to screening and surveillance in patients with BE.
The authors conditionally recommend performing surveillance and endoscopy for patients with nondysplastic BE. There is not sufficient evidence for the effectiveness of screening; if screening endoscopy is performed, the strategy should identify an at-risk population. Chromoendoscopy is strongly recommended for patients with BE undergoing surveillance, including virtual chromoendoscopy and Seattle protocol biopsy sampling compared with white-light endoscopy with Seattle protocol biopsy sampling. Routine use of confocal laser endomicroscopy is not recommended compared with white-light endoscopy with Seattle protocol biopsy sampling for patients with BE undergoing surveillance. Routine use of endoscopic ultrasound is not recommended for differentiation of mucosal versus submucosal disease in BE patients with high-grade dysplasia/intramucosal cancer or nodules. Use of wide-area transepithelial sampling with three-dimensional analysis is suggested in addition to Seattle protocol biopsy sampling for patients with known or suspected BE.
"Future studies that refine and validate existing prediction tools for screening of BE and esophageal adenocarcinoma are required," the authors write. "Future studies also need to focus on improved risk stratification of BE patients undergoing surveillance."
Several authors disclosed financial ties to the pharmaceutical, medical device, and medical technology industries.
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Posted: September 2019