ACG Clinical Guideline: Diagnosis and Management of Barrett's Esophagus

Nicholas J. Shaheen, Gary W. Falk, Prasad G Iyer, Lauren B. Gerson

Research output: Contribution to journalArticle

478 Citations (Scopus)

Abstract

Barrett's esophagus (BE) is among the most common conditions encountered by the gastroenterologist. In this document, the American College of Gastroenterology updates its guidance for the best practices in caring for these patients. These guidelines continue to endorse screening of high-risk patients for BE; however, routine screening is limited to men with reflux symptoms and multiple other risk factors. Acknowledging recent data on the low risk of malignant progression in patients with nondysplastic BE, endoscopic surveillance intervals are attenuated in this population; patients with nondysplastic BE should undergo endoscopic surveillance no more frequently than every 3-5 years. Neither routine use of biomarker panels nor advanced endoscopic imaging techniques (beyond high-definition endoscopy) is recommended at this time. Endoscopic ablative therapy is recommended for patients with BE and high-grade dysplasia, as well as T1a esophageal adenocarcinoma. Based on recent level 1 evidence, endoscopic ablative therapy is also recommended for patients with BE and low-grade dysplasia, although endoscopic surveillance continues to be an acceptable alternative. Given the relatively common recurrence of BE after ablation, we suggest postablation endoscopic surveillance intervals. Although many of the recommendations provided are based on weak evidence or expert opinion, this document provides a pragmatic framework for the care of the patient with BE.

Original languageEnglish (US)
Pages (from-to)30-50
Number of pages21
JournalAmerican Journal of Gastroenterology
Volume111
Issue number1
DOIs
StatePublished - Jan 1 2016

Fingerprint

Barrett Esophagus
Guidelines
Expert Testimony
Practice Guidelines
Endoscopy
Patient Care
Adenocarcinoma
Biomarkers
Recurrence
Therapeutics

ASJC Scopus subject areas

  • Gastroenterology

Cite this

ACG Clinical Guideline : Diagnosis and Management of Barrett's Esophagus. / Shaheen, Nicholas J.; Falk, Gary W.; Iyer, Prasad G; Gerson, Lauren B.

In: American Journal of Gastroenterology, Vol. 111, No. 1, 01.01.2016, p. 30-50.

Research output: Contribution to journalArticle

Shaheen, Nicholas J. ; Falk, Gary W. ; Iyer, Prasad G ; Gerson, Lauren B. / ACG Clinical Guideline : Diagnosis and Management of Barrett's Esophagus. In: American Journal of Gastroenterology. 2016 ; Vol. 111, No. 1. pp. 30-50.
@article{41c571cad8bf4d438a7d6fc3d92486e0,
title = "ACG Clinical Guideline: Diagnosis and Management of Barrett's Esophagus",
abstract = "Barrett's esophagus (BE) is among the most common conditions encountered by the gastroenterologist. In this document, the American College of Gastroenterology updates its guidance for the best practices in caring for these patients. These guidelines continue to endorse screening of high-risk patients for BE; however, routine screening is limited to men with reflux symptoms and multiple other risk factors. Acknowledging recent data on the low risk of malignant progression in patients with nondysplastic BE, endoscopic surveillance intervals are attenuated in this population; patients with nondysplastic BE should undergo endoscopic surveillance no more frequently than every 3-5 years. Neither routine use of biomarker panels nor advanced endoscopic imaging techniques (beyond high-definition endoscopy) is recommended at this time. Endoscopic ablative therapy is recommended for patients with BE and high-grade dysplasia, as well as T1a esophageal adenocarcinoma. Based on recent level 1 evidence, endoscopic ablative therapy is also recommended for patients with BE and low-grade dysplasia, although endoscopic surveillance continues to be an acceptable alternative. Given the relatively common recurrence of BE after ablation, we suggest postablation endoscopic surveillance intervals. Although many of the recommendations provided are based on weak evidence or expert opinion, this document provides a pragmatic framework for the care of the patient with BE.",
author = "Shaheen, {Nicholas J.} and Falk, {Gary W.} and Iyer, {Prasad G} and Gerson, {Lauren B.}",
year = "2016",
month = "1",
day = "1",
doi = "10.1038/ajg.2015.322",
language = "English (US)",
volume = "111",
pages = "30--50",
journal = "American Journal of Gastroenterology",
issn = "0002-9270",
publisher = "Nature Publishing Group",
number = "1",

}

TY - JOUR

T1 - ACG Clinical Guideline

T2 - Diagnosis and Management of Barrett's Esophagus

AU - Shaheen, Nicholas J.

AU - Falk, Gary W.

AU - Iyer, Prasad G

AU - Gerson, Lauren B.

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Barrett's esophagus (BE) is among the most common conditions encountered by the gastroenterologist. In this document, the American College of Gastroenterology updates its guidance for the best practices in caring for these patients. These guidelines continue to endorse screening of high-risk patients for BE; however, routine screening is limited to men with reflux symptoms and multiple other risk factors. Acknowledging recent data on the low risk of malignant progression in patients with nondysplastic BE, endoscopic surveillance intervals are attenuated in this population; patients with nondysplastic BE should undergo endoscopic surveillance no more frequently than every 3-5 years. Neither routine use of biomarker panels nor advanced endoscopic imaging techniques (beyond high-definition endoscopy) is recommended at this time. Endoscopic ablative therapy is recommended for patients with BE and high-grade dysplasia, as well as T1a esophageal adenocarcinoma. Based on recent level 1 evidence, endoscopic ablative therapy is also recommended for patients with BE and low-grade dysplasia, although endoscopic surveillance continues to be an acceptable alternative. Given the relatively common recurrence of BE after ablation, we suggest postablation endoscopic surveillance intervals. Although many of the recommendations provided are based on weak evidence or expert opinion, this document provides a pragmatic framework for the care of the patient with BE.

AB - Barrett's esophagus (BE) is among the most common conditions encountered by the gastroenterologist. In this document, the American College of Gastroenterology updates its guidance for the best practices in caring for these patients. These guidelines continue to endorse screening of high-risk patients for BE; however, routine screening is limited to men with reflux symptoms and multiple other risk factors. Acknowledging recent data on the low risk of malignant progression in patients with nondysplastic BE, endoscopic surveillance intervals are attenuated in this population; patients with nondysplastic BE should undergo endoscopic surveillance no more frequently than every 3-5 years. Neither routine use of biomarker panels nor advanced endoscopic imaging techniques (beyond high-definition endoscopy) is recommended at this time. Endoscopic ablative therapy is recommended for patients with BE and high-grade dysplasia, as well as T1a esophageal adenocarcinoma. Based on recent level 1 evidence, endoscopic ablative therapy is also recommended for patients with BE and low-grade dysplasia, although endoscopic surveillance continues to be an acceptable alternative. Given the relatively common recurrence of BE after ablation, we suggest postablation endoscopic surveillance intervals. Although many of the recommendations provided are based on weak evidence or expert opinion, this document provides a pragmatic framework for the care of the patient with BE.

UR - http://www.scopus.com/inward/record.url?scp=84955391043&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84955391043&partnerID=8YFLogxK

U2 - 10.1038/ajg.2015.322

DO - 10.1038/ajg.2015.322

M3 - Article

C2 - 26526079

AN - SCOPUS:84955391043

VL - 111

SP - 30

EP - 50

JO - American Journal of Gastroenterology

JF - American Journal of Gastroenterology

SN - 0002-9270

IS - 1

ER -