Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:


Watchful waiting no longer recommended for some high-risk Barrett's esophagus patients

New guidelines developed to address major clinical issues encountered in the treatment of Barrett's esophagus

Endoscopic removal of pre-cancerous cells in patients with confirmed, high-risk Barrett's esophagus is recommended rather than surveillance, according to a new "Medical Position Statement on the Management of Barrett's Esophagus," published by the American Gastroenterological Association (AGA) Institute. The medical position statement was published in Gastroenterology, the official journal of the AGA Institute.

In patients with Barrett's esophagus, the normal cells lining the esophagus are replaced with tissue that is similar to the lining of the intestine. The goal of endoscopic eradication therapy is to permanently eliminate all intestinal-type cells in the esophagus. A small number of people with Barrett's esophagus develop a rare, but often deadly, type of cancer of the esophagus.

"The AGA's recommendations for the treatment of patients with Barrett's esophagus are based on the best data currently available within the medical literature," said John M. Inadomi, MD, AGAF, chair of the AGA Clinical Practice & Quality Management Committee. "When considering whether surveillance or endoscopic eradication therapy is the preferred management option for patients with Barrett's esophagus, the AGA strongly supports the concept of shared decision-making between the treating physician and patient."

The AGA recommends endoscopic eradication therapy with radiofrequency ablation (RFA), photodynamic therapy (PDT) or endoscopic mucosal resection (EMR), as follows for various patient groups:

Patients with confirmed high-grade dysplasia (advanced pre-cancerous cells): endoscopic eradication therapy is recommended.

Patients with confirmed low-grade dysplasia (beginning pre-cancerous cells): endoscopic eradication therapy is a treatment option and should be discussed with patients as such.

Patients with Barrett's esophagus without abnormal cells: endoscopic eradication therapy is not recommended.

If eradication therapy is not indicated, is not available or is declined by a patient with Barrett's esophagus, surveillance by endoscopy should be performed every three months in patients with high-grade dysplasia, every six to 12 months in patients with low-grade dysplasia, and every three to five years in patients with no dysplasia.

"The recommendations in the medical position statement were made under the assumption that a patient's diagnosis and the presence or absence of low and high grade dysplasia would be accurate to the highest degree possible using the best current standards of practice," according to Stuart J. Spechler, MD, AGAF, a member of the AGA Institute Medical Position Panel. High grade dysplasia is an abnormal growth that has a high risk for cancer development.

Most patients (70 to 80 percent) with high-grade dysplasia can be successfully treated with endoscopic eradication therapy. Esophagectomy (surgical removal of all or part of the esophagus) in patients with high-grade dysplasia is an alternative; however, current evidence suggests that there is less morbidity with ablative therapy.

Other findings of the medical position statement on the management of Barrett's esophagus include:

In patients with multiple risk factors associated with esophageal cancer (age ¡Ý50 years, male gender, Caucasian, chronic gastroesophageal reflux disease [GERD], hiatal hernia, elevated body mass index and intra-abdominal distribution of body fat), AGA suggests screening for Barrett's esophagus. We recommend against screening the general population with GERD for Barrett's esophagus.

The diagnosis of dysplasia in Barrett's esophagus should be confirmed by at least one additional pathologist, preferably one who is an expert in esophageal histopathology.

For patients with Barrett's esophagus, GERD therapy with medication effective to treat GERD symptoms and to heal reflux is clearly indicated, as it is for patients without Barrett's esophagus. However, evidence to support the use of acid-reducing agents, specifically proton pump inhibitors, in patients with Barrett's esophagus solely to reduce the risk of progression to dysplasia or cancer is indirect and has not been proven in a long-term controlled trial.

Given that cardiovascular deaths are more common than deaths from esophageal cancer among patients with Barrett's esophagus, screening for cardiovascular risk factors and interventions is warranted.

It is expected that, each year, every one in 200 patients diagnosed with Barrett's esophagus will develop esophageal cancer, which is a devastating disease. For advanced esophageal cancers, the current treatment options are limited and odds of survival remain low; it is nearly universally terminal. However, while patients diagnosed with Barrett's esophagus, especially those with pre-cancerous cells, feel an increased level of anxiety and emotional burden, the actual risk of death from esophageal cancer remains low. Patients with Barrett's esophagus appear to have an increased risk of death from cardiovascular disease, perhaps due to an association with obesity.

The conclusions of the medical position statement are based on the best available evidence (as the technical review discusses), or in the absence of quality evidence, the expert opinions of the medical position panel convened to critique the technical review and structure the medical position statement.

To develop the guidelines, a set of 10 broad questions were identified by experts in the field to encapsulate the most common management questions faced by clinicians. To review recommendations and grades, view the American Gastroenterological Association Medical Position Statement on the Management of Barrett's Esophagus.

About the AGA Institute

The American Gastroenterological Association is the trusted voice of the GI community. Founded in 1897, the AGA has grown to include 17,000 members from around the globe who are involved in all aspects of the science, practice and advancement of gastroenterology. The AGA Institute administers the practice, research and educational programs of the organization.

About Gastroenterology

Gastroenterology, the official journal of the AGA Institute, is the most prominent scientific journal in the specialty and is in the top 1 percent of indexed medical journals internationally. The journal publishes clinical and basic science studies of all aspects of the digestive system, including the liver and pancreas, as well as nutrition. The journal is abstracted and indexed in Biological Abstracts, Current Awareness in Biological Sciences, Chemical Abstracts, Current Contents, Excerpta Medica, Index Medicus, Nutrition Abstracts and Science Citation Index. For more information, visit

Aimee Frank | EurekAlert!
Further information:

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Space observation with radar to secure Germany's space infrastructure

Satellites in near-Earth orbit are at risk due to the steady increase in space debris. But their mission in the areas of telecommunications, navigation or weather forecasts is essential for society. Fraunhofer FHR therefore develops radar-based systems which allow the detection, tracking and cataloging of even the smallest particles of debris. Satellite operators who have access to our data are in a better position to plan evasive maneuvers and prevent destructive collisions. From April, 25-29 2018, Fraunhofer FHR and its partners will exhibit the complementary radar systems TIRA and GESTRA as well as the latest radar techniques for space observation across three stands at the ILA Berlin.

The "traffic situation" in space is very tense: the Earth is currently being orbited not only by countless satellites but also by a large volume of space...

Im Focus: Researchers Discover New Anti-Cancer Protein

An international team of researchers has discovered a new anti-cancer protein. The protein, called LHPP, prevents the uncontrolled proliferation of cancer cells in the liver. The researchers led by Prof. Michael N. Hall from the Biozentrum, University of Basel, report in “Nature” that LHPP can also serve as a biomarker for the diagnosis and prognosis of liver cancer.

The incidence of liver cancer, also known as hepatocellular carcinoma, is steadily increasing. In the last twenty years, the number of cases has almost doubled...

Im Focus: Researchers at Fraunhofer monitor re-entry of Chinese space station Tiangong-1

In just a few weeks from now, the Chinese space station Tiangong-1 will re-enter the Earth's atmosphere where it will to a large extent burn up. It is possible that some debris will reach the Earth's surface. Tiangong-1 is orbiting the Earth uncontrolled at a speed of approx. 29,000 km/h.Currently the prognosis relating to the time of impact currently lies within a window of several days. The scientists at Fraunhofer FHR have already been monitoring Tiangong-1 for a number of weeks with their TIRA system, one of the most powerful space observation radars in the world, with a view to supporting the German Space Situational Awareness Center and the ESA with their re-entry forecasts.

Following the loss of radio contact with Tiangong-1 in 2016 and due to the low orbital height, it is now inevitable that the Chinese space station will...

Im Focus: Alliance „OLED Licht Forum“ – Key partner for OLED lighting solutions

Fraunhofer Institute for Organic Electronics, Electron Beam and Plasma Technology FEP, provider of research and development services for OLED lighting solutions, announces the founding of the “OLED Licht Forum” and presents latest OLED design and lighting solutions during light+building, from March 18th – 23rd, 2018 in Frankfurt a.M./Germany, at booth no. F91 in Hall 4.0.

They are united in their passion for OLED (organic light emitting diodes) lighting with all of its unique facets and application possibilities. Thus experts in...

Im Focus: Mars' oceans formed early, possibly aided by massive volcanic eruptions

Oceans formed before Tharsis and evolved together, shaping climate history of Mars

A new scenario seeking to explain how Mars' putative oceans came and went over the last 4 billion years implies that the oceans formed several hundred million...

All Focus news of the innovation-report >>>



Industry & Economy
Event News

New solar solutions for sustainable buildings and cities

23.03.2018 | Event News

Virtual reality conference comes to Reutlingen

19.03.2018 | Event News

Ultrafast Wireless and Chip Design at the DATE Conference in Dresden

16.03.2018 | Event News

Latest News

For graphite pellets, just add elbow grease

23.03.2018 | Materials Sciences

Unique communication strategy discovered in stem cell pathway controlling plant growth

23.03.2018 | Agricultural and Forestry Science

Sharpening the X-ray view of the nanocosm

23.03.2018 | Physics and Astronomy

Science & Research
Overview of more VideoLinks >>>