Barrett’s esophagus (BE) occurs due to chronic acid reflux, and the risk of developing esophageal cancer is between 30 and 125 times higher in patients with the condition.
Endoscopic eradication therapy (EET) can be used to effectively eradicate BE and related conditions, but it has a greater risk of harm and requires more resources than surveillance endoscopy.
A clinical practice guideline released by the American Gastroenterological Association (AGA) contains new recommendations for clinicians and patients regarding EET for BE and related neoplasia.
Researchers used the Grading of Recommendations Assessment, Development, and Evaluation framework to assess evidence. They used the Evidence-to-Decision Framework to develop recommendations regarding EET in patients with BE under the following scenarios.
Presence of high-grade dysplasia
A strong recommendation for EET in patients with high-grade dysplasia was made based on moderate certainty of evidence. After EET, regular surveillance should be conducted to monitor any recurrence or new developments.
Presence of low-grade dysplasia
Low-grade dysplasia carries a lower risk of progression, so a conditional recommendation was made in favor of EET. Patients who place a higher value on the potential harms and a lower value on the benefits (which are uncertain) regarding the reduction of esophageal cancer mortality could reasonably select surveillance endoscopy. Surveillance intervals should be adjusted after EET based on initial findings.
No dysplasia
As cells in nondysplastic BE are abnormal, they do not show dysplasia, leading to a recommendation against the use of EET due to low evidence regarding its effects in this patient group.
Choice of stepwise endoscopic mucosal resection (EMR) or focal EMR plus ablation
Based on a patient’s lesion characteristics, a conditional recommendation was made in favor of focal EMR plus ablation over stepwise EMR. Radiofrequency ablation is the preferred procedure for ablating remaining segments.
Endoscopic submucosal dissection (ESD) versus EMR
In patients with visible neoplastic lesions undergoing resection, the use of either EMR or ESD is suggested based on lesion characteristics. While EMR is typically suitable for most cases, ESD may be considered for more complex lesions.
Providers should engage in shared decision-making based on patient preferences.
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