Screening and surveillance of Barrett's esophagus: Updated ASGE guideline
The American Society for Gastrointestinal Endoscopy (ASGE) has released its updated "ASGE guideline on screening and surveillance of Barrett's esophagus," published in the September issue of GIE: Gastrointestinal Endoscopy.
The guideline aims to help clinicians understand the published literature and quality of available data on screening and surveillance in patients with Barrett's esophagus; a precancerous condition for esophageal adenocarcinoma. This document addresses several key clinical issues in this field, including the role and impact of screening and surveillance of Barrett's esophagus. As with other types of cancer, identifying this precancerous condition and early changes of cancer provides the best chance of successful treatment and, ultimately, improves patient outcomes.
Several endoscopic procedures and related technologies are used to screen and monitor patients with known or suspected Barrett's esophagus. If changes are found in the cells lining the esophagus, various endoscopic treatment approaches are available.
This guideline addresses the utility of advanced imaging and sampling modalities used during screening and surveillance endoscopic procedures and includes chromoendoscopy, confocal laser endomicroscopy, endoscopic ultrasound, wide-area transepithelial sampling (WATS) and others. Table 4 contains a summary of the recommendations.
The document complies with the standards of guideline development set forth by the Institute of Medicine for the creation of trustworthy guidelines and provides recommendations based on the GRADE framework.
"We are hopeful that this current information will help guide clinicians in using the growing array of tools and technologies available to us to diagnose and manage Barrett's esophagus, which, in turn, has the potential to significantly impact patient outcomes," said Sachin Wani, MD, FASGE, Chair of the ASGE Standards of Practice Committee.
Key Recommendations -
- In patients with NDBE, we suggest performing surveillance endoscopy compared with no surveillance (conditional recommendation, very low quality of evidence).
- There is insufficient evidence on the effectiveness of screening for BE. However, if screening endoscopy for BE is performed, we suggest a screening strategy that identifies an at-risk population, defining “at-risk” individuals as those with a family history of EAC or BE (high risk) or patients with GERD plus at least 1 other risk factor (moderate risk).
- In patients with BE undergoing surveillance, we recommend using CE or VC in addition to WLE and biopsy specimens obtained using the Seattle protocol compared with WLE and biopsy specimens obtained using the Seattle protocol alone (strong recommendation, moderate quality of evidence).
- In patients with BE undergoing surveillance, we suggest against routine use of CLE compared with WLE with Seattle protocol biopsy sampling (conditional recommendation, low quality of evidence).
- In BE patients with dysplasia or early EAC, we recommend against routine use of EUS to differentiate mucosal versus submucosal disease (strong recommendation, moderate quality of evidence).
- In patients with known or suspected BE, we suggest using WATS-3D in addition to WLE with Seattle protocol biopsy sampling compared with WLE with Seattle protocol biopsy sampling alone (conditional recommendation, low quality of evidence).
- There is insufficient evidence to make a recommendation for or against routine use of VLE in surveillance of patients with BE (no recommendation).