Consensus statements for management of Barrett's dysplasia and early-stage esophageal adenocarcinoma, based on a delphi process

Bennett C, Vakil N, Bergman J, Harrison R, Odze R, Vieth M, Sanders S, Gay L, Pech O, Longcroft-Wheaton G, Romero Y, Inadomi J, Tack J, Corley DA, Manner H, Green S, Al Dulaimi D, Ali H, Allum B, Anderson M, Curtis H, Falk G, Fennerty MB, Fullarton G, Krishnadath K, Meltzer SJ, Armstrong D, Ganz R, Cengia G, Going JJ, Goldblum J, Gordon C, Grabsch H, Haigh C, Hongo M, Johnston D, Forbes-Young R, Kay E, Kaye P, Lerut T, Lovat LB, Lundell L, Mairs P, Shimoda T, Spechler S, Sontag S, Malfertheiner P, Murray I, Nanji M, Poller D, Ragunath K, Regula J, Cestari R, Shepherd N, Singh R, Stein HJ, Talley NJ, Galmiche JP, Tham TC, Watson P, Yerian L, Rugge M, Rice TW, Hart J, Gittens S, Hewin D, Hochberger J, Kahrilas P, Preston S, Sampliner R, Sharma P, Stuart R, Wang K, Waxman I, Abley C, Loft D, Penman I, Shaheen NJ, Chak A, Davies G, Dunn L, Falck-Ytter Y, Decaestecker J, Bhandari P, Ell C, Griffin SM, Attwood S, Barr H, Allen J, Ferguson MK, Moayyedi P, Jankowski JA (2012)

Publication Type: Journal article

Publication year: 2012

Journal

Book Volume: 143

Pages Range: 336-346

Journal Issue: 2

DOI: 10.1053/j.gastro.2012.04.032

Abstract

Background & Aims: Esophageal adenocarcinoma (EA) is increasingly common among patients with Barrett's esophagus (BE). We aimed to provide consensus recommendations based on the medical literature that clinicians could use to manage patients with BE and low-grade dysplasia, high-grade dysplasia (HGD), or early-stage EA. Methods: We performed an international, multidisciplinary, systematic, evidence-based review of different management strategies for patients with BE and dysplasia or early-stage EA. We used a Delphi process to develop consensus statements. The results of literature searches were screened using a unique, interactive, Web-based data-sifting platform; we used 11,904 papers to inform the choice of statements selected. An a priori threshold of 80% agreement was used to establish consensus for each statement. Results: Eighty-one of the 91 statements achieved consensus despite generally low quality of evidence, including 8 clinical statements: (1) specimens from endoscopic resection are better than biopsies for staging lesions, (2) it is important to carefully map the size of the dysplastic areas, (3) patients that receive ablative or surgical therapy require endoscopic follow-up, (4) high-resolution endoscopy is necessary for accurate diagnosis, (5) endoscopic therapy for HGD is preferred to surveillance, (6) endoscopic therapy for HGD is preferred to surgery, (7) the combination of endoscopic resection and radiofrequency ablation is the most effective therapy, and (8) after endoscopic removal of lesions from patients with HGD, all areas of BE should be ablated. Conclusions: We developed a data-sifting platform and used the Delphi process to create evidence-based consensus statements for the management of patients with BE and early-stage EA. This approach identified important clinical features of the diseases and areas for future studies. © 2012 AGA Institute.

Authors with CRIS profile

Involved external institutions

Queen Alexandra Hospital United Kingdom (GB) Maidstone and Tunbridge Wells NHS Trust (MTW) United Kingdom (GB) Amsterdam University Medical Centers (Amsterdam UMC) / Amsterdam Universitair Medische Centra Netherlands (NL) McMaster University Canada (CA) Università degli Studi di Brescia Italy (IT) Glasgow Royal Infirmary (GRI) United Kingdom (GB) Tohoku University Hospital Japan (JP) Royal Infirmary of Edinburgh NHS Trust United Kingdom (GB) University of Washington United States (USA) (US) Trinity College Dublin Ireland (IE) University of Dallas United States (USA) (US) Royal Marsden Hospital / The Royal Marsden NHS Foundation Trust United Kingdom (GB) University of Newcastle (UoN) Australia (AU) University of Pennsylvania (UPenn) United States (USA) (US) Queen's University United Kingdom (GB) Oregon Health and Science University (OSHU) United States (USA) (US) Mayo Clinic United States (USA) (US) Durham University United Kingdom (GB) University Hospitals Coventry and Warwickshire United Kingdom (GB) University of North Carolina at Chapel Hill United States (USA) (US) Case Western Reserve University United States (USA) (US) Harrogate District Hospital United Kingdom (GB) Royal Victoria Infirmary United Kingdom (GB) Louis Stokes Cleveland VA Medical Center United States (USA) (US) Klinikum Bayreuth Germany (DE) Kaiser Permanente United States (USA) (US) Cleveland Clinic United States (USA) (US) University of Padua / Universita degli Studi di Padova Italy (IT) University of Minnesota (UMN) United States (USA) (US) Royal Bournemouth Hospital United Kingdom (GB) Northumbria Healthcare (NHS Foundation Trust) United Kingdom (GB) Nottingham University Hospitals United Kingdom (GB) Katholieke Universiteit Leuven (KUL) / Catholic University of Leuven Belgium (BE) University College London (UCL) United Kingdom (GB) National Cancer Center Hospital Japan (JP) University of Chicago United States (USA) (US) Oesophageal Cancer Fund Ireland (IE) University Hospitals of Leicester NHS Trust United Kingdom (GB) Gloucestershire Hospitals United Kingdom (GB) Queen Mary University of London United Kingdom (GB) University of Adelaide Australia (AU) University of Wisconsin - Madison United States (USA) (US) Warwick Medical School United Kingdom (GB) Nantes University Hospital / Centre hospitalier universitaire de Nantes (CHU) France (FR) University of Ulster United Kingdom (GB) St. Bernward Krankenhaus Germany (DE) Northwestern University United States (USA) (US) Barts Health NHS Trust United Kingdom (GB) Edward Hines Jr. VA Hospital United States (USA) (US) Otto-von-Guericke-Universität Magdeburg Germany (DE) Royal Cornwall Hospital / Treliske Hospital United Kingdom (GB) University of Arizona United States (USA) (US) University of Kansas (KU) United States (USA) (US) Johns Hopkins University (JHU) United States (USA) (US) University of Leeds United Kingdom (GB) Scottish Huntington's Association United Kingdom (GB) Karolinska Institute Sweden (SE) Darent Valley Hospital United Kingdom (GB) Maria Skłodowska-Curie Institute of Oncology / Centrum Onkologii–Instytut im. Marii Skłodowskiej-Curie w Warszawie Poland (PL) Städtisches Klinikum München Germany (DE) Harvard University United States (USA) (US) City Hospital United Kingdom (GB)

How to cite

APA:

Bennett, C., Vakil, N., Bergman, J., Harrison, R., Odze, R., Vieth, M.,... Jankowski, J.A. (2012). Consensus statements for management of Barrett's dysplasia and early-stage esophageal adenocarcinoma, based on a delphi process. Gastroenterology, 143(2), 336-346. https://doi.org/10.1053/j.gastro.2012.04.032

MLA:

Bennett, Cathy, et al. "Consensus statements for management of Barrett's dysplasia and early-stage esophageal adenocarcinoma, based on a delphi process." Gastroenterology 143.2 (2012): 336-346.

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