Consensus Statements for Management of Barrett's Dysplasia and Early-Stage Esophageal Adenocarcinoma, Based on a Delphi Process

被引：331

作者：

Bennett, Cathy ^{[1
]}

Vakil, Nimish ^{[2
]}

Bergman, Jacques ^{[3
]}

Harrison, Rebecca ^{[4
]}

Odze, Robert ^{[5
]}

Vieth, Michael ^{[6
]}

Sanders, Scott ^{[7
]}

Gay, Laura ^{[8
]}

Pech, Oliver ^{[6
]}

Longcroft-Wheaton, Gaius ^{[9
]}

Romero, Yvonne ^{[10
]}

Inadomi, John ^{[11
]}

Tack, Jan ^{[12
]}

Corley, Douglas A. ^{[13
]}

Manner, Hendrik ^{[14
]}

Green, Susi ^{[9
]}

Al Dulaimi, David

Ali, Haythem ^{[15
]}

Allum, Bill ^{[16
]}

Anderson, Mark ^{[17
]}

Curtis, Howard

Falk, Gary ^{[18
]}

Fennerty, M. Brian ^{[19
]}

Fullarton, Grant ^{[20
]}

Krishnadath, Kausilia ^{[3
]}

Meltzer, Stephen J. ^{[21
]}

Armstrong, David ^{[22
]}

Ganz, Robert ^{[23
]}

Cengia, Gianpaolo ^{[24
]}

Going, James J. ^{[20
]}

Goldblum, John ^{[25
]}

Gordon, Charles ^{[26
]}

Grabsch, Heike ^{[28
]}

Haigh, Chris

Hongo, Michio ^{[29
]}

Johnston, David ^{[30
]}

Forbes-Young, Ricky ^{[31
]}

Kay, Elaine ^{[32
]}

Kaye, Philip ^{[33
]}

Lerut, Toni ^{[12
]}

Lovat, Laurence B. ^{[34
]}

Lundell, Lars ^{[35
]}

Mairs, Philip

Shimoda, Tadakuza ^{[36
]}

Spechler, Stuart ^{[37
]}

Sontag, Stephen ^{[38
]}

Malfertheiner, Peter ^{[39
]}

Murray, Iain ^{[40
]}

Nanji, Manoj ^{[8
]}

Poller, David ^{[9
]}

机构：

[1] Queens Univ, Belfast, Antrim, North Ireland

[2] Univ Wisconsin, Sch Med & Publ Hlth, Madison, WI USA

[3] Amsterdam Med Ctr, Amsterdam, Netherlands

[4] Univ Hosp Leicester, Leicester, Leics, England

[5] Harvard Univ, Sch Med, Boston, MA USA

[6] Klinikum Bayreuth, Bayreuth, Germany

[7] Warwick Med Sch, Coventry, W Midlands, England

[8] Queen Mary Univ London, London, England

[9] Queen Alexandra Hosp, Portsmouth, Hants, England

[10] Mayo Clin, Rochester, MN USA

[11] Univ Washington, Seattle, WA USA

[12] Leuven Univ, Louvain, Belgium

[13] Kaiser Permanente, San Francisco, CA USA

[14] HSK Hosp, Wiesbaden, Germany

[15] Maidstone & Tunbridge Wells NHS trust, Maidstone, Kent, England

[16] Royal Marsden Hosp, London SW3 6JJ, England

[17] City Hosp, Birmingham, W Midlands, England

[18] Univ Penn, Philadelphia, PA 19104 USA

[19] Oregon Hlth & Sci Univ, Portland, OR 97201 USA

[20] Royal Infirm, Glasgow G31 2ER, Lanark, Scotland

[21] Johns Hopkins Univ, Sch Med, Baltimore, MD USA

[22] McMaster Univ, Hamilton, ON, Canada

[23] Bloomington Med Ctr, Bloomington, MN USA

[24] Univ Brescia, Brescia, Italy

[25] Cleveland Clin, Anat Pathol, Cleveland, OH 44106 USA

[26] Royal Bournemouth Hosp, Bournemouth, Dorset, England

[27] Univ Padua, Padua, Italy

[28] Univ Leeds, Leeds, W Yorkshire, England

[29] Tohoku Univ Hosp, Tohoku, Japan

[30] Ninewells Hosp, Dundee DD1 9SY, Scotland

[31] Royal Infirm, Edinburgh, Midlothian, Scotland

[32] Trinity Coll Dublin, Dublin, Ireland

[33] Univ Nottingham Hosp, Ctr Digest Dis, Nottingham NG7 2UH, England

[34] UCL, London, England

[35] CLINTEC, Karolinska Inst, Stockholm, Sweden

[36] Natl Canc Ctr, Tokyo 104, Japan

[37] Univ Dallas, Dallas, TX USA

[38] Hines Vet Affairs Hosp, Chicago, IL USA

[39] Univ Magdeburg, D-39106 Magdeburg, Germany

[40] Royal Cornwall Hosp, Truro, England

[41] Inst Oncol, Warsaw, Poland

[42] Univ Adelaide, Lyell McEwin Hosp, Adelaide, SA, Australia

[43] Polyclin Klinikum Munchen, Munich, Germany

[44] Univ Newcastle, Newcastle, NSW 2300, Australia

[45] CHU, Dept Gastroenterol, Nantes, France

[46] Univ Nantes, Nantes, France

[47] Ulster Hosp, Belfast, Antrim, North Ireland

[48] Univ Chicago, Chicago, IL 60637 USA

[49] ECD Solut, Bridgetown, St Michael, Barbados

[50] St Bernward Hosp, Hildesheim, Germany

来源：

GASTROENTEROLOGY | 2012年 / 143卷 / 02期

关键词：

BADCAT; Esophageal Cancer; Treatment Strategy; Systematic Analysis; HIGH-GRADE DYSPLASIA; GASTROESOPHAGEAL-REFLUX DISEASE; ENDOSCOPIC MUCOSAL RESECTION; LONG-TERM SURVIVAL; RADIOFREQUENCY ABLATION; INTESTINAL METAPLASIA; PHOTODYNAMIC THERAPY; SURGICAL-TREATMENT; INTRAEPITHELIAL NEOPLASIA; RISK-FACTORS;

D O I：

10.1053/j.gastro.2012.04.032

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

100201 [内科学];

摘要：

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.

引用

页码：336 / 346

页数：11

共 123 条

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Multifocal neoplasia and nodal metastases in T1 esophageal carcinoma - Implications for endoscopic treatment [J].