Featured Research

from universities, journals, and other organizations

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

Date:
March 1, 2011
Source:
American Gastroenterological Association
Summary:
Endoscopic removal of pre-cancerous cells in patients with confirmed, high-risk Barrett's esophagus is recommended rather than surveillance, according to a new position statement.

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.

Related Articles


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 ≥50 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.


Story Source:

The above story is based on materials provided by American Gastroenterological Association. Note: Materials may be edited for content and length.


Cite This Page:

American Gastroenterological Association. "Watchful waiting no longer recommended for some high-risk Barrett's esophagus patients." ScienceDaily. ScienceDaily, 1 March 2011. <www.sciencedaily.com/releases/2011/03/110301091217.htm>.
American Gastroenterological Association. (2011, March 1). Watchful waiting no longer recommended for some high-risk Barrett's esophagus patients. ScienceDaily. Retrieved November 27, 2014 from www.sciencedaily.com/releases/2011/03/110301091217.htm
American Gastroenterological Association. "Watchful waiting no longer recommended for some high-risk Barrett's esophagus patients." ScienceDaily. www.sciencedaily.com/releases/2011/03/110301091217.htm (accessed November 27, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Thursday, November 27, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Pet Dogs to Be Used in Anti-Ageing Trial

Pet Dogs to Be Used in Anti-Ageing Trial

Reuters - Innovations Video Online (Nov. 26, 2014) Researchers in the United States are preparing to discover whether a drug commonly used in human organ transplants can extend the lifespan and health quality of pet dogs. Video provided by Reuters
Powered by NewsLook.com
Today's Prostheses Are More Capable Than Ever

Today's Prostheses Are More Capable Than Ever

Newsy (Nov. 26, 2014) Advances in prosthetics are making replacement body parts stronger and more lifelike than they’ve ever been. Video provided by Newsy
Powered by NewsLook.com
From Popcorn To Vending Snacks: FDA Ups Calorie Count Rules

From Popcorn To Vending Snacks: FDA Ups Calorie Count Rules

Newsy (Nov. 25, 2014) The US FDA is announcing new calorie rules on Tuesday that will require everywhere from theaters to vending machines to include calorie counts. Video provided by Newsy
Powered by NewsLook.com
Daily Serving Of Yogurt Could Reduce Risk Of Type 2 Diabetes

Daily Serving Of Yogurt Could Reduce Risk Of Type 2 Diabetes

Newsy (Nov. 25, 2014) Need another reason to eat yogurt every day? Researchers now say it could reduce a person's risk of developing type 2 diabetes. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins