September 10, 2019
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ASGE releases updated screening, surveillance guidelines for BE

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Sachin Wani

ASGE has released updated guidelines for the screening and surveillance of Barrett’s esophagus.

With the goal of improving morbidity and mortality related to esophageal adenocarcinoma (EAC), ASGE’s latest standards address clinical questions including the impact and role of screening and surveillance as well as the utility of sampling modalities and advanced imaging like volumetric laser endomicroscopy (VLE), chromoendoscopy, confocal laser endomicroscopy, wide-area transepithelial sampling and endoscopic ultrasound (EUS).

“The incidence of EAC continues to be among the fastest rising incidence cancers in the Western population and has been closely mirrored by a rise in EAC-related mortality,” Sachin Wani, MD, FASGE, chair of the ASGE Standards of Practice Committee, and colleagues wrote. “To ultimately impact the morbidity and mortality associated with EAC, several national and international medical societies recommend screening for BE in individuals with multiple risk factors and surveillance when the diagnosis of BE is established.”

Guidelines were established based on systematic reviews from available literature regarding five clinical questions related to BE, while recommendations for strength and quality of evidence were calculated using the GRADE methodology. Existing systematic reviews were used to draft initial guidelines for each question, and a new systematic review was conducted with the assistance of an expert librarian if no existing review could be found. GRADE methodologists assisted in the creation of evidence profiles, with recommendations drafted by a panel at a standards of practice meeting in March 2018.

Major recommendations from the report include:

  • Surveillance endoscopy is recommended for patients with nondysplastic BE.
  • If a screening endoscopy is performed for BE, a screening strategy that identifies an at-risk population should be used.
  • For patients with BE undergoing surveillance, chromoendoscopy, such as Seattle protocol biopsy sampling and virtual chromoendoscopy, are recommended over white-light endoscopy with Seattle protocol biopsy sampling.
  • ASGE recommends against routine use of confocal laser endomicroscopy as opposed to white-light endoscopy with Seattle protocol biopsy sampling.
  • ASGE recommends against routine use of EUS to differentiate submucosal and mucosal disease in patients with BE also with high-grade dysplasia, intramucosal carcinoma or nodules.
  • WATS-3D in addition to Seattle protocol biopsy sampling are recommended over white-light endoscopy with Seattle protocol biopsy sampling in patients with suspected or known BE.
  • Insufficient evidence is present to recommend for or against routine VLE in patients with BE undergoing surveillance.

“Future studies that refine and validate existing prediction tools for screening of BE and EAC are required,” the authors wrote. “Before we embrace the new generation of less-invasive and potentially less-expensive screening techniques and replace our current approach of using standard endoscopy for screening, these new techniques need to demonstrate high diagnostic performance characteristics, easy implementation at a primary care level, high uptake in the at-risk population and low cost.” – by Eamon Dreisbach

Disclosures: Qumseya reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.