AGA recommends endoscopic eradication vs. surveillance for BE with high-grade dysplasia

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Key takeaways:

  • The AGA strongly recommends endoscopic eradication therapy over surveillance for BE with high-grade dysplasia.
  • The AGA suggests against routine use of endoscopic eradication therapy in nondysplastic BE.

In a new clinical practice guideline, the AGA provides evidence-based recommendations for use of endoscopic eradication therapy in the management of Barrett’s esophagus, accounting for the presence of dysplasia and other scenarios.

“The advent of endoscopic eradication therapy (EET) for treatment of dysplasia and early-stage cancer has revolutionized the management of Barrett’s esophagus, reducing the morbidity and mortality related to esophagectomy and ultimately preventing esophageal adenocarcinoma mortality,” Joel H. Rubenstein, MD, MSc, professor and director of the Barrett’s Esophagus Program at Michigan Medicine and research scientist at the VA Center for Clinical Management Research in Ann Arbor, and colleagues wrote in Gastroenterology.

Key takeaways from the AGA’s clinical practice guideline on Barrett’s esophagus.

Data derived from: Rubenstein JH, et al. Gastroenterology. 2024;doi:10.1053/j.gastro.2024.03.019.

Using the evidence-to-decision framework, Rubenstein and colleagues developed recommendations based on the presence of high-grade, low-grade or no dysplasia, or choice of stepwise endoscopic mucosal resection (EMR) vs. focal EMR with ablation and endoscopic submucosal dissection (ESD) vs. EMR. They based clinical recommendations on the balance between desirable and undesirable effects, patient values, cost and health equity considerations.

Highlights include:

  • Among those with BE with high-grade dysplasia, the AGA strongly recommends EET over surveillance. For patients with BE with low-grade dysplasia, the AGA suggests EET over surveillance.
  • The AGA suggests against the routine use of EET among those with nondysplastic BE.
  • Among patients undergoing EET, the AGA suggests resection of visible lesions followed by ablation of the remaining BE segment over resection of the whole segment.
  • The AGA suggests use of EMR or ESD based on lesion characteristics among patients with BE with visible neoplastic lesions undergoing endoscopic resection.

“These evidence reviews identified several important knowledge gaps that future research should address,” Rubenstein and colleagues wrote. “Future update of this guideline will depend on the availability of new evidence on the existing interventions and new intervention. We hope to incorporate the advances in the technological platforms and models of guideline development in the future updates without duplication or reproduction of the current guideline document.”

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