Recommendations Issued for Endoscopic Eradication Therapy in Barrett Esophagus

THURSDAY, May 23, 2024 (HealthDay News) -- In a clinical practice guideline issued by the American Gastroenterological Association and published online in the June issue of Gastroenterology, updated evidence-based recommendations are presented for the use of endoscopic eradication therapy (EET) in patients with Barrett esophagus (BE) and related neoplasia.

Joel H. Rubenstein, M.D., from the Lieutenant Colonel Charles S. Kettles Veterans Affairs Medical Center in Ann Arbor, Michigan, and colleagues agreed on five recommendations for EET use in BE and related neoplasia. The panel made a strong recommendation for EET in patients with BE high-grade dysplasia and a conditional recommendation against EET in BE without dysplasia based on the available evidence.

In addition, the authors made a conditional recommendation in favor of EET in BE low-grade dysplasia and noted that surveillance endoscopy could reasonably be selected for patients with BE low-grade dysplasia who place a higher value on the potential harms and lower value on the uncertain benefits regarding reduction of esophageal cancer mortality. A conditional recommendation was made in favor of focal endoscopic mucosal resection (EMR) plus ablation over stepwise EMR in patients with visible lesions. The use of either EMR or endoscopic submucosal dissection was suggested based on lesion characteristics for patients with visible neoplastic lesions undergoing resection.

"While the benefit is clear for patients with high-grade dysplasia, we suggest considering endoscopic eradication therapy for patients with low-grade dysplasia after clearly discussing the risks and benefits of endoscopic therapy," coauthor Tarek Sawas, M.D., from the University of Texas Southwestern in Dallas, said in a statement.

Several authors disclosed ties to the biopharmaceutical and medical device industries.

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