The American Society for Gastrointestinal Endoscopy has released new guidelines on the use of endoscopic eradication therapy in patients with Barrett’s esophagus-related dysplasia and intramucosal cancer.
The ASGE Standards of Practice Committee developed the guideline to address any problems gastroenterologists might encounter when treating patients with Barrett’s esophagus (BE)-related neoplasia, according to committee chair Sachin Wani, MD, FASGE, associate professor of medicine at the University of Colorado Anschutz Medical Campus.
“This document also includes a clinical decision tool for practicing [gastroenterologists] that summarizes these guidelines and allow for easy implementation in clinical practice,” Wani told Healio Gastroenterology and Liver Disease.
The guideline authors note that endoscopic eradication therapy (EET) has changed the management of patients with BE-related lesions and provides a technique that is much less invasive than surgical esophagectomy.
The key recommendations in the guideline are as follows, according to Wani:
- For patients with high-grade (HGD) or low-grade dysplasia (LGD) being considered for EET, the diagnosis of dysplasia should be confirmed by at least one expert GI pathologist or a panel of pathologists vs. review by a single pathologist;
- Patients with HGD should undergo EET vs. surveillance;
- Patients with LGD should undergo EET, unless they are strongly risk-averse, in which case surveillance is acceptable;
- EET is strongly recommended vs. surgery for patients with BE-related HGD or intramucosal cancer;
- Endoscopic mucosal resection (EMR) of all visible lesions within the Barrett’s segment is strongly recommended;
- The panel strongly recommends against routine EMR of the entire Barrett’s segment vs. EMR of visible lesions followed by ablation of the remaining Barrett’s segment;
- Ablation of the remaining Barrett’s esophagus after visible lesions undergo EMR is suggested to reduce the risk for metachronous neoplasia; and
- Until better risk stratification tools are available, it is suggested that patients are enrolled in a surveillance program to detect recurrences after achieving the goal of EET – complete eradication of intestinal metaplasia.
“The ultimate goal of this endeavor is to improve and optimize the care of patients with Barrett’s esophagus-related neoplasia,” Wani said. – by Alex Young
Wani reports being a consultant for Medtronic and Boston Scientific. He is also supported by the University of Colorado Department of Medicine Outstanding Early Scholars Program. Please see the full guideline for the other authors’ relevant financial disclosures.