GuidelineASGE guideline on screening and surveillance of Barrett’s esophagus
Section snippets
General Considerations for Screening and Surveillance
Screening is the mechanism through which populations may be assessed to identify individuals who have a disease or a preclinical condition that predisposes to a disease. Surveillance is the program through which these at-risk individuals are periodically assessed or examined to identify disease at a stage amenable to cure.15 The evidence to support screening and surveillance endoscopy, a practice that has been recommended by national guidelines,4, 12, 13, 14 is highly variable and based on
Aims and Scope
The aim of this document is to offer evidence-based recommendations and clinical guidelines addressing key issues related to screening and surveillance in patients with BE. The panel considered the following clinical questions:
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What is the role of surveillance endoscopy in patients with NDBE compared with no surveillance in decreasing the rate of cancer progression, EAC-related mortality, and all-cause mortality?
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What is the role of screening for BE in the general population and at-risk
Overview
This guideline document was based on systematic reviews (SRs) of the available literature for each clinical question. The quality or certainty in the evidence and strength of recommendations was based on the GRADE framework. When existing SRs were identified, they were used to inform the guideline when appropriate. If no existing SRs were found, a new SR (and meta-analysis [MA], when possible) was conducted with the help of an expert librarian. Evidence profiles were created with the help of
Results
The recommendations for each clinical question are summarized in Table 4.
Question 1: What is the role of surveillance endoscopy in patients with NDBE compared with no surveillance in decreasing the rate of cancer progression, EAC-related mortality, and all-cause mortality?
Recommendation: In patients with NDBE, we suggest performing surveillance endoscopy compared with no surveillance (conditional recommendation, very low quality of evidence).
Summary of the evidence: Surveillance endoscopy for
Future Directions
This document highlights several knowledge gaps in the field of screening and surveillance for BE. First and foremost, we still lack high-quality evidence on the benefits of screening and surveillance in patients with BE specifically addressing key outcomes such as incidence, morbidity, and mortality associated with EAC. In this document, we discuss the best design for future studies to address this critical issue. Future studies that refine and validate existing prediction tools for screening
Summary and Conclusions
In this document, the ASGE offers evidence-based clinical practice guidelines on topics regarding screening and surveillance for BE. These guidelines follow the GRADE framework and offer guidance on several key clinical questions such as the role and impact of screening and surveillance in patients with BE and the role of advanced imaging techniques in BE patients undergoing surveillance endoscopy. This guideline complies with the standards for guideline development set forth by the Institute
Acknowledgment
The panel thanks John Bastian for his contributions from the patient perspective.
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The final document was approved by the ASGE Governing Board and the Standards of Practice Committee and represents the official guideline of the ASGE on these topics.
DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: M. Al-Haddad: Teaching and research support from Boston Scientific. J. Buxbaum: Consultant for Olympus. J. Dewitt: Consultant for Olympus America and Boston Scientific; grant support from Pinnacle Biologics. D. Fishman: Contributor to UpToDate. B. Jacobson: Consultant for Motus GI, Remedy Partners, and Dark Canyon, LLC. L. Jamil: Consultant and speaker for Aries Pharmaceutical. M. Khashab: Consultant and medical advisory board for Boston Scientific and Olympus; consultant for Medtronic. M. McCarter: Medical advisory board for Debbies Dream Foundation. N. Thosani: Consultant for Pentax America, Boston Scientific, Medtronic, and Endogastric Solutions; speaker for AbbVie. S. Wani: Consultant for Medtronic and Boston Scientific; supported by University of Colorado Department of Medicine Outstanding Early Scholars Program. All other authors disclosed no financial relationships relevant to this publication.
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Drs Qumseya and Sultan contributed equally to this article.