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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Am+J+Gastroenterol
2015 ; 110
(5
): 662-82; quiz 683
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
BOB CAT: A Large-Scale Review and Delphi Consensus for Management of Barrett s
Esophagus With No Dysplasia, Indefinite for, or Low-Grade Dysplasia
#MMPMID25869390
Bennett C
; Moayyedi P
; Corley DA
; DeCaestecker J
; Falck-Ytter Y
; Falk G
; Vakil N
; Sanders S
; Vieth M
; Inadomi J
; Aldulaimi D
; Ho KY
; Odze R
; Meltzer SJ
; Quigley E
; Gittens S
; Watson P
; Zaninotto G
; Iyer PG
; Alexandre L
; Ang Y
; Callaghan J
; Harrison R
; Singh R
; Bhandari P
; Bisschops R
; Geramizadeh B
; Kaye P
; Krishnadath S
; Fennerty MB
; Manner H
; Nason KS
; Pech O
; Konda V
; Ragunath K
; Rahman I
; Romero Y
; Sampliner R
; Siersema PD
; Tack J
; Tham TC
; Trudgill N
; Weinberg DS
; Wang J
; Wang K
; Wong JY
; Attwood S
; Malfertheiner P
; MacDonald D
; Barr H
; Ferguson MK
; Jankowski J
Am J Gastroenterol
2015[May]; 110
(5
): 662-82; quiz 683
PMID25869390
show ga
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.