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Am J Gastroenterol. 2015 May;110(5):662-82; quiz 683. doi: 10.1038/ajg.2015.55. Epub 2015 Apr 14.

BOB CAT: A Large-Scale Review and Delphi Consensus for Management of Barrett's Esophagus With No Dysplasia, Indefinite for, or Low-Grade Dysplasia.

Author information

1
Centre for Technology Enabled Health Research, Coventry University, Coventry, UK.
2
McMaster University, Hamilton, Ontario, Canada.
3
Kaiser Permanente, Oakland, California, USA.
4
Leicester General Hospital, Leicester, UK.
5
Case Western Reserve University School of Medicine, Case and VA Medical Center Cleveland, Cleveland, Ohio, USA.
6
University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
7
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
8
NHS Foundation Trust, Warwick, UK.
9
Klinikum Bayreuth, Bayreuth, Germany.
10
University of Washington School of Medicine, Seattle, Washington, USA.
11
Worcestershire Acute Hospitals NHS Trust, Redditch, UK.
12
National University Health System, Singapore, Singapore.
13
Brigham and Women's Hospital, Boston, Massachusetts, USA.
14
Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
15
Weill Cornell Medical College and Houston Methodist Hospital, Houston, Texas, USA.
16
ECD Solutions, Columbus, Ohio, USA.
17
Queen's University, Belfast, UK.
18
Imperial College, St Mary's Hospital, London, UK.
19
Mayo Clinic, Rochester, Minnesota, USA.
20
Norwich Medical School, University of East Anglia, Norwich, UK.
21
University of Manchester, Manchester, UK.
22
Department of Gastroenterology, University Hospital Southampton, Southampton, UK.
23
Lyell McEwin Hospital/University of Adelaide, Adelaide, South Australia, Australia.
24
Queen Alexandra Hospital, Portsmouth, UK.
25
University Hospitals Leuven, Leuven, Belgium.
26
Department of Pathology, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
27
Nottingham University Hospitals NHS Trust, Nottingham, UK.
28
Gastrointestinal Oncology Research Group, AMC, Amsterdam, The Netherlands.
29
Oregon Health and Science University, Portland, Oregon, USA.
30
Department of Gastroenterology HSK Wiesbaden, Wiesbaden, Germany.
31
University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
32
Krankenhaus Barmherzige Brueder, Regensburg, Germany.
33
University of Chicago, Chicago, Illinois, USA.
34
Queens Medical Centre, University of Nottingham, Nottingham, UK.
35
University Hospital Southampton, Southampton, UK.
36
University of Arizona Cancer Center, Tucson, Arizona, USA.
37
University Medical Center Utrecht, Utrecht, The Netherlands.
38
University of Leuven, Leuven, Belgium.
39
Ulster Hospital, Belfast, Northern Ireland, UK.
40
Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK.
41
Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.
42
Washington University School of Medicine, Saint Louis, Missouri, USA.
43
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
44
Durham University, Durham, UK.
45
Otto-Von-Guericke-Universität Magdeburg, Magdeburg, Germany.
46
University of British Columbia, Vancouver, British Columbia, Canada.
47
Gloucestershire Royal Hospital, Gloucester, UK.
48
The University of Chicago Medicine, Chicago, Illinois, USA.
49
University Hospitals Coventry and Warwickshire and University of Warwick, Coventry, UK.

Abstract

OBJECTIVES:

Barrett's esophagus (BE) is a common premalignant lesion for which surveillance is recommended. This strategy is limited by considerable variations in clinical practice. We conducted an international, multidisciplinary, systematic search and evidence-based review of BE and provided consensus recommendations for clinical use in patients with nondysplastic, indefinite, and low-grade dysplasia (LGD).

METHODS:

We defined the scope, proposed statements, and searched electronic databases, yielding 20,558 publications that were screened, selected online, and formed the evidence base. We used a Delphi consensus process, with an 80% agreement threshold, using GRADE (Grading of Recommendations Assessment, Development and Evaluation) to categorize the quality of evidence and strength of recommendations.

RESULTS:

In total, 80% of respondents agreed with 55 of 127 statements in the final voting rounds. Population endoscopic screening is not recommended and screening should target only very high-risk cases of males aged over 60 years with chronic uncontrolled reflux. A new international definition of BE was agreed upon. For any degree of dysplasia, at least two specialist gastrointestinal (GI) pathologists are required. Risk factors for cancer include male gender, length of BE, and central obesity. Endoscopic resection should be used for visible, nodular areas. Surveillance is not recommended for <5 years of life expectancy. Management strategies for indefinite dysplasia (IND) and LGD were identified, including a de-escalation strategy for lower-risk patients and escalation to intervention with follow-up for higher-risk patients.

CONCLUSIONS:

In this uniquely large consensus process in gastroenterology, we made key clinical recommendations for the escalation/de-escalation of BE in clinical practice. We made strong recommendations for the prioritization of future research.

PMID:
25869390
PMCID:
PMC4436697
DOI:
10.1038/ajg.2015.55
[Indexed for MEDLINE]
Free PMC Article

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