title: BOB CAT: A Large-Scale Review and Delphi Consensus for Management of Barrett's Esophagus With No Dysplasia, Indefinite for, or Low-Grade Dysplasia.
abstract: OBJECTIVE
  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.
authors: Centre for Technology Enabled Health Research, Coventry University, Coventry, UK.
authors: Cathy
authors: C
authors: Bennett
authors: McMaster University, Hamilton, Ontario, Canada.
authors: Paul
authors: P
authors: Moayyedi
authors: Kaiser Permanente, Oakland, California, USA.
authors: Douglas A
authors: DA
authors: Corley
authors: Leicester General Hospital, Leicester, UK.
authors: John
authors: J
authors: DeCaestecker
authors: Case Western Reserve University School of Medicine, Case and VA Medical Center Cleveland, Cleveland, Ohio, USA.
authors: Yngve
authors: Y
authors: Falck-Ytter
authors: University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
authors: Gary
authors: G
authors: Falk
authors: University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors: Nimish
authors: N
authors: Vakil
authors: NHS Foundation Trust, Warwick, UK.
authors: Scott
authors: S
authors: Sanders
authors: Klinikum Bayreuth, Bayreuth, Germany.
authors: Michael
authors: M
authors: Vieth
authors: University of Washington School of Medicine, Seattle, Washington, USA.
authors: John
authors: J
authors: Inadomi
authors: Worcestershire Acute Hospitals NHS Trust, Redditch, UK.
authors: David
authors: D
authors: Aldulaimi
authors: National University Health System, Singapore, Singapore.
authors: Khek-Yu
authors: KY
authors: Ho
authors: Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors: Robert
authors: R
authors: Odze
authors: Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors: Stephen J
authors: SJ
authors: Meltzer
authors: Weill Cornell Medical College and Houston Methodist Hospital, Houston, Texas, USA.
authors: Eamonn
authors: E
authors: Quigley
authors: ECD Solutions, Columbus, Ohio, USA.
authors: Stuart
authors: S
authors: Gittens
authors: Queen's University, Belfast, UK.
authors: Peter
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authors: Watson
authors: Imperial College, St Mary's Hospital, London, UK.
authors: Giovanni
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authors: Zaninotto
authors: Mayo Clinic, Rochester, Minnesota, USA.
authors: Prasad G
authors: PG
authors: Iyer
authors: Norwich Medical School, University of East Anglia, Norwich, UK.
authors: Leo
authors: L
authors: Alexandre
authors: University of Manchester, Manchester, UK.
authors: Yeng
authors: Y
authors: Ang
authors: Department of Gastroenterology, University Hospital Southampton, Southampton, UK.
authors: James
authors: J
authors: Callaghan
authors: Leicester General Hospital, Leicester, UK.
authors: Rebecca
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authors: Harrison
authors: Lyell McEwin Hospital/University of Adelaide, Adelaide, South Australia, Australia.
authors: Rajvinder
authors: R
authors: Singh
authors: Queen Alexandra Hospital, Portsmouth, UK.
authors: Pradeep
authors: P
authors: Bhandari
authors: University Hospitals Leuven, Leuven, Belgium.
authors: Raf
authors: R
authors: Bisschops
authors: Department of Pathology, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors: Bita
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authors: Geramizadeh
authors: Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors: Philip
authors: P
authors: Kaye
authors: Gastrointestinal Oncology Research Group, AMC, Amsterdam, The Netherlands.
authors: Sheila
authors: S
authors: Krishnadath
authors: Oregon Health and Science University, Portland, Oregon, USA.
authors: M Brian
authors: MB
authors: Fennerty
authors: Department of Gastroenterology HSK Wiesbaden, Wiesbaden, Germany.
authors: Hendrik
authors: H
authors: Manner
authors: University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors: Katie S
authors: KS
authors: Nason
authors: Krankenhaus Barmherzige Brueder, Regensburg, Germany.
authors: Oliver
authors: O
authors: Pech
authors: University of Chicago, Chicago, Illinois, USA.
authors: Vani
authors: V
authors: Konda
authors: Queens Medical Centre, University of Nottingham, Nottingham, UK.
authors: Krish
authors: K
authors: Ragunath
authors: University Hospital Southampton, Southampton, UK.
authors: Imdadur
authors: I
authors: Rahman
authors: Mayo Clinic, Rochester, Minnesota, USA.
authors: Yvonne
authors: Y
authors: Romero
authors: University of Arizona Cancer Center, Tucson, Arizona, USA.
authors: Richard
authors: R
authors: Sampliner
authors: University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Peter D
authors: PD
authors: Siersema
authors: University of Leuven, Leuven, Belgium.
authors: Jan
authors: J
authors: Tack
authors: Ulster Hospital, Belfast, Northern Ireland, UK.
authors: Tony C K
authors: TC
authors: Tham
authors: Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK.
authors: Nigel
authors: N
authors: Trudgill
authors: Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.
authors: David S
authors: DS
authors: Weinberg
authors: Washington University School of Medicine, Saint Louis, Missouri, USA.
authors: Jean
authors: J
authors: Wang
authors: Mayo Clinic, Rochester, Minnesota, USA.
authors: Kenneth
authors: K
authors: Wang
authors: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors: Jennie Y Y
authors: JY
authors: Wong
authors: Durham University, Durham, UK.
authors: Stephen
authors: S
authors: Attwood
authors: Otto-Von-Guericke-Universität Magdeburg, Magdeburg, Germany.
authors: Peter
authors: P
authors: Malfertheiner
authors: University of British Columbia, Vancouver, British Columbia, Canada.
authors: David
authors: D
authors: MacDonald
authors: Gloucestershire Royal Hospital, Gloucester, UK.
authors: Hugh
authors: H
authors: Barr
authors: The University of Chicago Medicine, Chicago, Illinois, USA.
authors: Mark K
authors: MK
authors: Ferguson
authors: University Hospitals Coventry and Warwickshire and University of Warwick, Coventry, UK.
authors: Janusz
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authors: Jankowski
mesh_terms: D055011:Ablation Techniques; D000367:Age Factors; D001471:Barrett Esophagus / Q000473:pathology* / Q000628:therapy*; D014408:Biomarkers, Tumor / Q000032:analysis*; D001706:Biopsy; D032921:Consensus; D019175:DNA Methylation; D003697:Delphi Technique; D004938:Esophageal Neoplasms / Q000473:pathology*; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology*; D006801:Humans; D011230:Precancerous Conditions / Q000737:chemistry / Q000235:genetics / Q000473:pathology* / Q000628:therapy*; D012307:Risk Factors; D012737:Sex Factors; D057832:Watchful Waiting / Q000379:methods
chemical_list: D014408:Biomarkers, Tumor