title: British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus.
abstract: These guidelines provide a practical and evidence-based resource for the management of patients with Barrett's oesophagus and related early neoplasia. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was followed to provide a methodological strategy for the guideline development. A systematic review of the literature was performed for English language articles published up until December 2012 in order to address controversial issues in Barrett's oesophagus including definition, screening and diagnosis, surveillance, pathological grading for dysplasia, management of dysplasia, and early cancer including training requirements. The rigour and quality of the studies was evaluated using the SIGN checklist system. Recommendations on each topic were scored by each author using a five-tier system (A+, strong agreement, to D+, strongly disagree). Statements that failed to reach substantial agreement among authors, defined as >80% agreement (A or A+), were revisited and modified until substantial agreement (>80%) was reached. In formulating these guidelines, we took into consideration benefits and risks for the population and national health system, as well as patient perspectives. For the first time, we have suggested stratification of patients according to their estimated cancer risk based on clinical and histopathological criteria. In order to improve communication between clinicians, we recommend the use of minimum datasets for reporting endoscopic and pathological findings. We advocate endoscopic therapy for high-grade dysplasia and early cancer, which should be performed in high-volume centres. We hope that these guidelines will standardise and improve management for patients with Barrett's oesophagus and related neoplasia.
authors.affiliation: MRC Cancer Unit, University of Cambridge, Cambridge, UK.
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Fitzgerald
authors.forename: Massimiliano
authors.initials: M
authors.lastname: di Pietro
authors.forename: Krish
authors.initials: K
authors.lastname: Ragunath
authors.forename: Yeng
authors.initials: Y
authors.lastname: Ang
authors.forename: Jin-Yong
authors.initials: JY
authors.lastname: Kang
authors.forename: Peter
authors.initials: P
authors.lastname: Watson
authors.forename: Nigel
authors.initials: N
authors.lastname: Trudgill
authors.forename: Praful
authors.initials: P
authors.lastname: Patel
authors.forename: Philip V
authors.initials: PV
authors.lastname: Kaye
authors.forename: Scott
authors.initials: S
authors.lastname: Sanders
authors.forename: Maria
authors.initials: M
authors.lastname: O'Donovan
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bird-Lieberman
authors.forename: Pradeep
authors.initials: P
authors.lastname: Bhandari
authors.forename: Janusz A
authors.initials: JA
authors.lastname: Jankowski
authors.forename: Stephen
authors.initials: S
authors.lastname: Attwood
authors.forename: Simon L
authors.initials: SL
authors.lastname: Parsons
authors.forename: Duncan
authors.initials: D
authors.lastname: Loft
authors.forename: Jesper
authors.initials: J
authors.lastname: Lagergren
authors.forename: Paul
authors.initials: P
authors.lastname: Moayyedi
authors.forename: Georgios
authors.initials: G
authors.lastname: Lyratzopoulos
authors.forename: John
authors.initials: J
authors.lastname: de Caestecker
mesh_terms: D055011:Ablation Techniques; D000230:Adenocarcinoma / Q000175:diagnosis / Q000191:economics / Q000209:etiology / Q000628:therapy; D001471:Barrett Esophagus / Q000150:complications / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D001706:Biopsy; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000191:economics / Q000209:etiology / Q000628:therapy; D016629:Esophagectomy; D004945:Esophagoscopy / Q000191:economics / Q000379:methods; D004947:Esophagus / Q000473:pathology / Q000601:surgery; D006801:Humans; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D006113:United Kingdom; D014481:United States
keywords: BARRETT'S CARCINOMA; BARRETT'S METAPLASIA; BARRETT'S OESOPHAGUS; GASTROESOPHAGEAL REFLUX DISEASE; OESOPHAGEAL CANCER