In a recent publication in Gastroenterology, the American Gastroenterological Association (AGA) published new clinical practice guidelines to provide prescribers and patients with evidence-based practice recommendations for using EET in Barrett’s esophagus (BE) and related neoplasia.
The authors highlighted the key recommendations, including the following:
• Removing or monitoring the cells may be appropriate for patients with low-grade dysplasia. Clinicians and patients should use shared decision-making, including discussing the risks and benefits of treatment
• For patients with high-grade dysplasia, the AGA recommends endoscopic therapy to eliminate the abnormal precancerous cells
• Most patients undergoing EET can be safely treated with endoscopic mucosal resection (EMR), which has a lower risk of adverse events. Patients who undergo endoscopic submucosal dissection (ESD) may have an augmented risk of strictures and perforation. The AGA recommends reserving ESD primarily for lesions suspected of harboring cancers invading more deeply into the wall of the esophagus or those who have failed EMR
• Patients with BE (dysplasia or early cancer) should be treated and monitored by expert endoscopists and pathologists who have experience in Barrett’s neoplasia.
Based on their recommendations, the authors concluded that the new guidelines provide a comprehensive outline of the indications for EET in managing BE and related neoplasia. Moreover, the new guidelines also provide considerations surrounding EET implementation.
The panel of experts wrote, “Providers should engage in shared decision-making based on patient preferences. Limitations and gaps in the evidence are highlighted to guide future research opportunities.”
Takek Sawas, University of Texas Southwestern, Division of Digestive and Liver Disease, Dallas, one of the panel experts, stated, “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. A patient-centered approach ensures that treatment decision is made collaboratively, taking into account both the medical evidence and the patient’s preferences and values. Surveillance is a reasonable option for patients who place a higher value on harms and a lower value on the uncertain benefits regarding reduction of esophageal cancer mortality.”
Lead author Joel Rubenstein, chair of the Clinical Guidelines Committee of the AGA, stated, “We need to have a conversation with patients in the clinic prior to when they show up in the endoscopy unit on a gurney. Patients need to be fully aware of the risks and benefits, both in the short term and also in the long run, to decide which treatment approach is best for them. This decision often comes down to personal factors and values.”
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