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22-03-2011 | Gastroenterology | Article

AGA lowers endoscopic eradication treatment threshold for BE

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MedWire News: Endoscopic eradication therapy should be favored over surveillance for Barrett's esophagus (BE) patients with confirmed high-grade dysplasia, says the American Gastroenterological Association (AGA).

The advice is contained in an AGA Institute Medical Position Statement, published in the journal Gastroenterology.

"Confirmed" dysplasia refers to that diagnosed by at least two pathologists, one of whom should ideally be an expert in esophageal histopathology.

Endoscopic eradication therapy - with radiofrequency ablation, photodynamic therapy, or endoscopic mucosal resection - is not advised in the absence of dysplasia. However, the AGA believes it should be an option for patients with confirmed low-grade dysplasia. It is even recommended for "select patients" with nondysplastic BE who are thought to be at increased risk for progression to high-grade dysplasia or cancer.

"We recognize the controversies surrounding both definition and management of dysplasia in BE, and that the risk of progression to cancer in this population of patients can vary greatly among individuals," say the statement's authors.

John Inadomi, statement author and chair of the AGA Clinical Practice & Quality Management Committee, said: "When considering whether surveillance or endoscopic eradication therapy is the preferred management option for patients with BE, the AGA strongly supports the concept of shared decision-making between the treating physician and patient."

Regular surveillance is advised for patients not yet in need of treatment: every 3-5 years for patients without dysplasia; every 6-12 months for those with low-grade dysplasia; and every 3 months for untreated patients with high-grade dysplasia.

Among other recommendations, the position statement notes that there is no strong evidence that treating gastroesophageal reflux or giving patients aspirin can prevent esophageal cancer. However, it does recommend screening patients for cardiovascular risk factors, and providing aspirin if necessary.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Eleanor McDermid