Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Aug;143(2):336-46.
doi: 10.1053/j.gastro.2012.04.032. Epub 2012 Apr 24.

Consensus statements for management of Barrett's dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process

Cathy Bennett  1 , Nimish Vakil, Jacques Bergman, Rebecca Harrison, Robert Odze, Michael Vieth, Scott Sanders, Laura Gay, Oliver Pech, Gaius Longcroft-Wheaton, Yvonne Romero, John Inadomi, Jan Tack, Douglas A Corley, Hendrik Manner, Susi Green, David Al Dulaimi, Haythem Ali, Bill Allum, Mark Anderson, Howard Curtis, Gary Falk, M Brian Fennerty, Grant Fullarton, Kausilia Krishnadath, Stephen J Meltzer, David Armstrong, Robert Ganz, Gianpaolo Cengia, James J Going, John Goldblum, Charles Gordon, Heike Grabsch, Chris Haigh, Michio Hongo, David Johnston, Ricky Forbes-Young, Elaine Kay, Philip Kaye, Toni Lerut, Laurence B Lovat, Lars Lundell, Philip Mairs, Tadakuza Shimoda, Stuart Spechler, Stephen Sontag, Peter Malfertheiner, Iain Murray, Manoj Nanji, David Poller, Krish Ragunath, Jaroslaw Regula, Renzo Cestari, Neil Shepherd, Rajvinder Singh, Hubert J Stein, Nicholas J Talley, Jean-Paul Galmiche, Tony C K Tham, Peter Watson, Lisa Yerian, Massimo Rugge, Thomas W Rice, John Hart, Stuart Gittens, David Hewin, Juergen Hochberger, Peter Kahrilas, Sean Preston, Richard Sampliner, Prateek Sharma, Robert Stuart, Kenneth Wang, Irving Waxman, Chris Abley, Duncan Loft, Ian Penman, Nicholas J Shaheen, Amitabh Chak, Gareth Davies, Lorna Dunn, Yngve Falck-Ytter, John Decaestecker, Pradeep Bhandari, Christian Ell, S Michael Griffin, Stephen Attwood, Hugh Barr, John Allen, Mark K Ferguson, Paul Moayyedi, Janusz A Z Jankowski
Affiliations

Consensus statements for management of Barrett's dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process

Cathy Bennett et al. Gastroenterology. 2012 Aug.

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest

These authors disclose the following: Janusz Jankowski is a paid consultant to AstraZeneca UK and Almirall and a grant holder from FALK. He is Chief Investigator for the AspECT and CHoPIN trials, which are supported by AstraZeneca. Cathy Bennett is the proprietor of Systematic Research Ltd and received a consultancy fee for her work on this consensus document. Paul Moayyedi is a consultant to AstraZeneca. Nimish Vakil is a consultant to Astra Zeneca, Takeda, Ironwood, Restech, and Orexo. Robert Ganz is the primary inventor and the cofounder of BÂRRX Medical, holds equity in the company, and serves as a paid consultant. Peter Kahrilas performs ad hoc consulting for AstraZeneca, Eisai, EndoGastric Solutions, and Ironwood, and serves on advisory boards for Torax and Reckitt Benckiser. Michio Hongo is a consultant to Abbott Japan, AstraZeneca Japan, AstellasPharma, Daiichi-Sankyo, Dainippon Sumitomo Pharma, Eisai, Kissei Pharmaceutical, Takeda Pharmaceutical, Scampo Pharma, and Zelia Pharmaceutical. Yvonne Romero is a consultant to AstraZeneca, Santarus, Takeda, Kala, Pfizer, and Aptalis. David Armstrong has received one or more of the following: educational and research grants, honoraria, consulting fees, and related travel expenses from Abbott Laboratories, AltanaPharma, AstraZeneca, Axcan, Eisai Limited, Gilead, Janssen Ortho Inc, Merck, NPS Pharmaceuticals, Nycomed, Olympus Canada Inc, Pentax Medical Inc, Pfizer, Proctor & Gamble, Schering-Plough, Shire Canada, Takeda Canada, Warner-Chilcott, and XenoPort Inc. Richard Sampliner received a BÂRRX research grant. Oliver Pech is a consultant to Hitachi Medical, Fujinon, Norgine, and AstraZeneca. Jaroslaw Regula is a consultant to Abbott, Astellas, AstraZeneca, Krka, MSD, Polpharma, Sandoz, and Warner-Chilcott.M. Brian Fennerty is a consultant for Aptalis, Oncoscope, and Meridian Bioscience. Nicholas Talley has had grant support from Falk, Forest, Janssen, and Takeda, has been a consultant for ARYx, Astellas, Astra Zeneca, Boehringer Ingleheim, Care Capitol, ConCERT, Edusa, Falk, Focus Medical Communications, Forest, Ironwood, Janssen, Johnson & Johnson, Meritage, NicOx, Novartis, Prometheus, Salix, Sanofi-Adventis, Shire, Tranzyme, Theravance, XenoPort, and Zeria, and is a key opinion leader for Doyen Medical Inc. John de Caestecker is Chair of AspECT Trial Management Group, which is AstraZeneca supported. Jacques Bergman is a consultant for Boston Scientific and has research support from BÂRRX Medical, Olympus, and Cook. Stephen Attwood is on the aspect trial management committee, which is AstraZeneca supported. JeanPaul Galmiche is a consultant and speaker for Given Imaging, Mauna Kea Technologies, Shire, Norgine, and Xenoport. His institution has received research grants from AstraZeneca, Janssen Cilag France, ADDEX, and Pentax. Laurence Lovat is on the Advisory Board of Ninepoint Medical and performed ad hoc consulting for Given Imaging and research support for Axcan Pharma, DUSA Pharmaceuticals, and BÂRRX. Peter Watson is a member of AspECT Trial Management Group, which is AstraZeneca sponsored. Kenneth Wang is a consultant to BÂRRX, Ironwood Pharma, CDX Diagnostics, Pinnacle Pharma, and CSA. David Johnston has received speaker’s fees and support to attend educational meetings from AstraZeneca. Krish Ragunath received research support, educational grants and speaker honoraria from Olympus Keymed, Cook Medical and BÂRRX Medical. Stuart Gittens is managing director of ECD solutions web data handling company. The remaining authors disclose no conflicts.

Figures

Figure 1
Figure 1
Proportion of statements achieving consensus with each round of voting. With each round voting improved with iterative changes to the question and supporting evidence.
Figure 2
Figure 2
Management of HGD and/or mucosal cancer (stage T1m) in BE. This consensus has allowed the development of a care pathway for HGD and early adenocarcinoma.
See this image and copyright information in PMC

Comment in

References

    1. Vakil NJ, van Zanten SV, Kahrilas P, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101:1900–1920. - PubMed
    1. Ford AC, Forman D, Reynolds PD, et al. Ethnicity, gender, and socioeconomic status as risk factors for esophagitis and Barrett’s esophagus. Am J Epidemiol. 2005;162:454–460. - PubMed
    1. Taylor JB, Rubenstein JH. Meta-analyses of the effect of symptoms of gastroesophageal reflux on the risk of Barrett’s esophagus. Am J Gastroenterol. 2010;105:1730–1737. - PMC - PubMed
    1. Ronkainen J, Talley NJ, Storskrubb T, et al. Erosive esophagitis is a risk factor for Barrett’s esophagus: a community-based endoscopic follow-up study. Am J Gastroenterol. 2011;106:1946–1952. - PubMed
    1. Moayyedi P, Axon AT. Review article: gastro-esophageal reflux disease—the extent of the problem. Aliment Pharmacol Ther. 2005;22(Suppl 1):11–19. - PubMed

Publication types

MeSH terms