The American College of Gastroenterology made substantial changes to the clinical guidelines on the diagnosis and management of Barrett's esophagus.
Nicholas J. Shaheen, MD, and colleagues published the guideline online in the American Journal of Gastroenterology on Nov. 3, according to Medscape.
Here are seven notes:
1. ACG made the changes due to advances in the use of endoscopic ablative therapy, data supporting less frequent endoscopic surveillance for patients with nondysplastic BE and data showing that many women with gastroesophageal reflux disease can safely skip routine BE screening.
2. The authors said the most significant changes reflect rapid advances in BE treatment. They wrote, "No aspect of these guidelines has evolved more since the last guideline iteration than therapeutic aspects of BE. Most profound of these changes is our markedly augmented ability to provide effective endoscopic therapy for subjects with neoplastic BE."
3. In the guideline, the authors expanded recommendations on methods for close inspection of the BE mucosa to inform decisions on endoscopic therapy.
4. Additionally, the recommendations include the expanded use of endoscopic ablative therapy, including the use in patients with low-grade dysplasia.
5. Because of the low risk for progression to esophageal adenocarcinoma, the ACG advises against endoscopic ablative therapies in patients with nondysplastic BE and no dysplasia on EMR.
6. The ACG recommends EMRs should be followed by endoscopic ablative therapy for patients with LGD or high-grade dysplasia whose lesions were completely resected.
7. In the guideline, the ACG states women with gastroesophageal reflux disease symptoms are no longer candidates for routine endoscopic screening in the absence of multiple risk factors such as age older than 50 years, Caucasian race, chronic and/or frequent gastroesophageal reflux disease, central obesity, waist circumference larger than 88 cm, smoking or confirmed family history of BE or esophageal adenocarcinoma.
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