Diagnosis and management of barrett's esophagus, 2022 ACG guidelines recommended at a glance

In recent years, the incidence of Barrett's esophagus (BE) has been increasing worldwide, as the only known precancerous lesion of esophageal adenocarcinoma, its diagnosis and treatment, screening has a very important role

diagnosis

1.

(conditional recommendation, very low-quality evidence)

2.

(Conditional recommendation, low-quality evidence)

3.

(Conditional recommendation, low-quality evidence)

4.

(Highly recommended, low-quality evidence)

Screening

5.

(conditional recommendation, very low-quality evidence)

6.
Swallowable, non-endoscopic capsule devices combined with biomarker detection can be used as an alternative to
endoscopic screening for BE.

(conditional recommendation, very low-quality evidence)

7.
Repeated screening is not recommended for patients with a negative initial endoscopic screening
result.

(Conditional recommendation, low-quality evidence)

monitoring

8.
Standard white light endoscopy and pigment endoscopy can be used for endoscopic monitoring
of BE patients.

(Highly recommended, medium quality evidence)

9.
A structured biopsy regimen is recommended to minimize bias
in endoscopic monitoring of patients with BE.

(Highly recommended, low-quality evidence)

10.
The interval between endoscopic monitoring in patients with BE is determined
by the grading of dysplasia.

(conditional recommendation, very low-quality evidence)

11.
It is recommended to consider the length of non-dysplasia (NDBE) segments when setting the monitoring interval, with long segments OF BE (≥3 cm) monitored every 3 years and short segments OF BE (<3 cm) monitored every 5 years
.

(Highly recommended, medium quality evidence)

12.
There are no recommended recommendations for the analysis of intermediate computer-assisted three-dimensional wide-area cross-epithelial sampling (WATS-3D) in endoscopic monitoring of PATIENTS WITH BE
.

13.
In addition to standard histopathology, there are no recommended recommendations
for the use of other predictive tools (P53 protein immunostaining and The TissueCypher system) in endoscopic monitoring of PATIENTS WITH BE.

Medication and surgery

14.
For PATIENTS WITH BE without a history of proton pump inhibitor (PPI) allergy or other contraindications to use, PPI therapy is at
least once daily.

(conditional recommendation, very low-quality evidence)

15.
There are no recommendations for aspirin plus PPI therapy to reduce the risk of progression to severe dysplasia (HGD) or esophageal adenocarcinoma in patients with BE
.

16.
Anti-reflux surgery is not recommended as an antitumor measure in patients
with BE.

(Conditional recommendation, low-quality evidence)

Endoscopic treatment

17.
Endoscopic eradication therapy (EET) is recommended for PATIENTS WITH BE of HGD/intramucosal carcinoma (IMC) than for esophageal resection
.

(Highly recommended, medium quality evidence)

18.
For PATIENTS WITH BE with low-grade dysplasia (LGD), endoscopic therapy is recommended to reduce the risk of progression to HGD or esophageal adenocarcinoma, and endoscopic monitoring of confirmed LGD is an acceptable option
.

(Conditional recommendation, medium-quality evidence)

19.
It is recommended that patients with BE undergo initial endoscopic resection (ER)
of all visible lesions prior to ablation therapy with EET.

(conditional recommendation, very low-quality evidence)

20.
Patients with BE are recommended to receive EET treatment at high-volume medical centers
.

(conditional recommendation, very low-quality evidence)

21.
Endoscopic monitoring
of PATIENTS WITH BE who successfully completes EET is recommended.

(Highly recommended, medium quality evidence)

Compiled from: Shaheen NJ, Falk GW, Iyer PG, et al.
Diagnosis and Management ofBarrett's Esophagus: An Updated ACG Guideline.
Am J Gastroenterol.
2022 Apr1; 117(4):559-587.