TY - JOUR
T1 - British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus
AU - Fitzgerald, Rebecca C
AU - di Pietro, Massimiliano
AU - Ragunath, Krish
AU - Ang, Yeng
AU - Kang, Jin-Yong
AU - Watson, Peter
AU - Trudgill, Nigel
AU - Patel, Praful
AU - Kaye, Philip V
AU - Sanders, Scott
AU - O'Donovan, Maria
AU - Bird-Lieberman, Elizabeth
AU - Bhandari, Pradeep
AU - Jankowski, Janusz A
AU - Attwood, Stephen
AU - Parsons, Simon L
AU - Loft, Duncan
AU - Lagergren, Jesper
AU - Moayyedi, Paul
AU - Lyratzopoulos, Georgios
AU - de Caestecker, John
AU - British Society of Gastroenterology
PY - 2014/1
Y1 - 2014/1
N2 - These guidelines provide a practical and evidence-based resource for the management of patients with Barrett's oesophagus and related early neoplasia. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was followed to provide a methodological strategy for the guideline development. A systematic review of the literature was performed for English language articles published up until December 2012 in order to address controversial issues in Barrett's oesophagus including definition, screening and diagnosis, surveillance, pathological grading for dysplasia, management of dysplasia, and early cancer including training requirements. The rigour and quality of the studies was evaluated using the SIGN checklist system. Recommendations on each topic were scored by each author using a five-tier system (A+, strong agreement, to D+, strongly disagree). Statements that failed to reach substantial agreement among authors, defined as >80% agreement (A or A+), were revisited and modified until substantial agreement (>80%) was reached. In formulating these guidelines, we took into consideration benefits and risks for the population and national health system, as well as patient perspectives. For the first time, we have suggested stratification of patients according to their estimated cancer risk based on clinical and histopathological criteria. In order to improve communication between clinicians, we recommend the use of minimum datasets for reporting endoscopic and pathological findings. We advocate endoscopic therapy for high-grade dysplasia and early cancer, which should be performed in high-volume centres. We hope that these guidelines will standardise and improve management for patients with Barrett's oesophagus and related neoplasia.
AB - These guidelines provide a practical and evidence-based resource for the management of patients with Barrett's oesophagus and related early neoplasia. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was followed to provide a methodological strategy for the guideline development. A systematic review of the literature was performed for English language articles published up until December 2012 in order to address controversial issues in Barrett's oesophagus including definition, screening and diagnosis, surveillance, pathological grading for dysplasia, management of dysplasia, and early cancer including training requirements. The rigour and quality of the studies was evaluated using the SIGN checklist system. Recommendations on each topic were scored by each author using a five-tier system (A+, strong agreement, to D+, strongly disagree). Statements that failed to reach substantial agreement among authors, defined as >80% agreement (A or A+), were revisited and modified until substantial agreement (>80%) was reached. In formulating these guidelines, we took into consideration benefits and risks for the population and national health system, as well as patient perspectives. For the first time, we have suggested stratification of patients according to their estimated cancer risk based on clinical and histopathological criteria. In order to improve communication between clinicians, we recommend the use of minimum datasets for reporting endoscopic and pathological findings. We advocate endoscopic therapy for high-grade dysplasia and early cancer, which should be performed in high-volume centres. We hope that these guidelines will standardise and improve management for patients with Barrett's oesophagus and related neoplasia.
KW - Ablation Techniques
KW - Adenocarcinoma
KW - Barrett Esophagus
KW - Biopsy
KW - Cost-Benefit Analysis
KW - Decision Support Techniques
KW - Early Detection of Cancer
KW - Esophageal Neoplasms
KW - Esophagectomy
KW - Esophagoscopy
KW - Esophagus
KW - Great Britain
KW - Humans
KW - Risk Assessment
KW - Risk Factors
KW - United States
U2 - 10.1136/gutjnl-2013-305372
DO - 10.1136/gutjnl-2013-305372
M3 - Article
C2 - 24165758
VL - 63
SP - 7
EP - 42
JO - Gut
JF - Gut
SN - 0017-5749
IS - 1
ER -