Abstract：
Barrett\'s esophagus (BE) is the precursor to esophageal adenocarcinoma (EAC). Endoscopic eradication therapy (EET) can be effective in eradicating BE and related neoplasia and has greater risk of harms and resource use than surveillance endoscopy. This clinical practice guideline aims to inform clinicians and patients by providing evidence-based practice recommendations for the use of EET in BE and related neoplasia.
The Grading of Recommendations Assessment, Development and Evaluation framework was used to assess evidence and make recommendations. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients, conducted an evidence review, and used the Evidence-to-Decision Framework to develop recommendations regarding the use of EET in patients with BE under the following scenarios: presence of (1) high-grade dysplasia, (2) low-grade dysplasia, (3) no dysplasia, and (4) choice of stepwise endoscopic mucosal resection (EMR) or focal EMR plus ablation, and (5) endoscopic submucosal dissection vs EMR. Clinical recommendations were based on the balance between desirable and undesirable effects, patient values, costs, and health equity considerations.
The panel agreed on 5 recommendations for the use of EET in BE and related neoplasia. Based on the available evidence, the panel made a strong recommendation in favor of EET in patients with BE high-grade dysplasia and conditional recommendation against EET in BE without dysplasia. The panel made a conditional recommendation in favor of EET in BE low-grade dysplasia; patients with BE low-grade dysplasia who place a higher value on the potential harms and lower value on the benefits (which are uncertain) regarding reduction of esophageal cancer mortality could reasonably select surveillance endoscopy. In patients with visible lesions, a conditional recommendation was made in favor of focal EMR plus ablation over stepwise EMR. In patients with visible neoplastic lesions undergoing resection, the use of either endoscopic mucosal resection or endoscopic submucosal dissection was suggested based on lesion characteristics.
This document provides a comprehensive outline of the indications for EET in the management of BE and related neoplasia. Guidance is also provided regarding the considerations surrounding implementation of EET. Providers should engage in shared decision making based on patient preferences. Limitations and gaps in the evidence are highlighted to guide future research opportunities.
The Grading of Recommendations Assessment, Development and Evaluation framework was used to assess evidence and make recommendations. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients, conducted an evidence review, and used the Evidence-to-Decision Framework to develop recommendations regarding the use of EET in patients with BE under the following scenarios: presence of (1) high-grade dysplasia, (2) low-grade dysplasia, (3) no dysplasia, and (4) choice of stepwise endoscopic mucosal resection (EMR) or focal EMR plus ablation, and (5) endoscopic submucosal dissection vs EMR. Clinical recommendations were based on the balance between desirable and undesirable effects, patient values, costs, and health equity considerations.
The panel agreed on 5 recommendations for the use of EET in BE and related neoplasia. Based on the available evidence, the panel made a strong recommendation in favor of EET in patients with BE high-grade dysplasia and conditional recommendation against EET in BE without dysplasia. The panel made a conditional recommendation in favor of EET in BE low-grade dysplasia; patients with BE low-grade dysplasia who place a higher value on the potential harms and lower value on the benefits (which are uncertain) regarding reduction of esophageal cancer mortality could reasonably select surveillance endoscopy. In patients with visible lesions, a conditional recommendation was made in favor of focal EMR plus ablation over stepwise EMR. In patients with visible neoplastic lesions undergoing resection, the use of either endoscopic mucosal resection or endoscopic submucosal dissection was suggested based on lesion characteristics.
This document provides a comprehensive outline of the indications for EET in the management of BE and related neoplasia. Guidance is also provided regarding the considerations surrounding implementation of EET. Providers should engage in shared decision making based on patient preferences. Limitations and gaps in the evidence are highlighted to guide future research opportunities.
摘要：
目的：Barrett食管（BE）是食管腺癌（EAC）的前体。内镜根除治疗（EET）可以有效根除BE和相关瘤形成，并且比监测内镜检查具有更大的危害和资源使用风险。本临床实践指南旨在通过为在BE和相关瘤形成中使用EET提供循证实践建议来告知临床医生和患者。
方法：建议评估的分级，开发和评估框架用于评估证据并提出建议。小组根据临床医生和患者的重要性，优先考虑临床问题和结果，进行了证据审查，并使用证据到决策框架来制定关于在以下情况下对BE患者使用EET的建议：存在（1）高度发育不良，(2)低度发育不良,(3)无发育不良,（4）选择逐步内镜黏膜切除术（EMR）或局灶性EMR加消融，（5）内镜黏膜下剥离术与EMR的比较。临床建议基于理想和不良效果之间的平衡，患者价值观,成本,和健康公平考虑。
结果：专家组同意在BE和相关瘤形成中使用EET的5项建议。根据现有证据,专家组提出了在有BE高度发育不良的患者中支持EET的强烈推荐和在无发育不良的BE中反对EET的有条件推荐.专家组提出了有条件的建议，支持EET用于BE低度发育不良；BE低度发育不良患者在降低食管癌死亡率方面对潜在危害的重视程度较高，对益处的重视程度较低（不确定），可以合理选择监测内镜检查。在有可见病变的患者中，有条件的建议支持局灶性EMR加消融,而不是逐步EMR.在进行切除的可见肿瘤性病变的患者中，根据病变特点,建议使用内镜黏膜切除术或内镜黏膜下剥离术.
结论：本文件全面概述了EET在BE和相关瘤形成治疗中的适应症。还提供了有关实施EET的注意事项的指导。提供者应根据患者的偏好进行共享决策。强调了证据的局限性和差距，以指导未来的研究机会。
方法：建议评估的分级，开发和评估框架用于评估证据并提出建议。小组根据临床医生和患者的重要性，优先考虑临床问题和结果，进行了证据审查，并使用证据到决策框架来制定关于在以下情况下对BE患者使用EET的建议：存在（1）高度发育不良，(2)低度发育不良,(3)无发育不良,（4）选择逐步内镜黏膜切除术（EMR）或局灶性EMR加消融，（5）内镜黏膜下剥离术与EMR的比较。临床建议基于理想和不良效果之间的平衡，患者价值观,成本,和健康公平考虑。
结果：专家组同意在BE和相关瘤形成中使用EET的5项建议。根据现有证据,专家组提出了在有BE高度发育不良的患者中支持EET的强烈推荐和在无发育不良的BE中反对EET的有条件推荐.专家组提出了有条件的建议，支持EET用于BE低度发育不良；BE低度发育不良患者在降低食管癌死亡率方面对潜在危害的重视程度较高，对益处的重视程度较低（不确定），可以合理选择监测内镜检查。在有可见病变的患者中，有条件的建议支持局灶性EMR加消融,而不是逐步EMR.在进行切除的可见肿瘤性病变的患者中，根据病变特点,建议使用内镜黏膜切除术或内镜黏膜下剥离术.
结论：本文件全面概述了EET在BE和相关瘤形成治疗中的适应症。还提供了有关实施EET的注意事项的指导。提供者应根据患者的偏好进行共享决策。强调了证据的局限性和差距，以指导未来的研究机会。
