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Management of Barrett esophagus: a practical guide for clinicians based on the BADCAT and BoB CAT recommendations
DOI: 10.20452/pamw.3119
Published online: September 23, 2015
We undertook two of the largest evidence-based reviews in clinical medicine to assess the rationale
for the management of gastroesophageal reflux disease, Barrett esophagus (BE), dysplasia, and early
invasive esophageal adenocarcinoma. These reviews involved over 150 world experts in 4 continents,
and over 20 000 papers were assessed. Quality assessment of the publications was made using Grading
of Recommendations Assessment, Development and Evaluation, and of over 240 questions formulated,
we were able to answer 30% with an agreement of at least 80%. We agreed on a unique global definition
of BE meaning that the presence both of hiatus hernia endoscopically and of intestinal metaplasia
histologically should be noted. In addition, we devised an escalation and deescalation pathway for the
management of esophagitis, metaplasia, dysplasia, and adenocarcinoma sequence. Endoscopic resection
(ER) is recommended for visible mucosal lesions. Moreover, we endorsed the early use of ablation therapy
for persistent dysplasia of any degree. In this regard, ER may be both diagnostic and therapeutic and
may be sufficient even in early mucosal lesions (T1m). In conclusion, fewer people should be surveyed
but those that do will require more detailed mapping and endoscopic interventions than currently. In
addition, patients accumulating other potentially life-threaten-ing comorbidities should be offered cessation
of surveillance. In the future, chemoprevention may be the game-changing solution but results
from large randomized trials, including AspECT and BOSS, are awaited.
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