Consensus Statements for Management of Barretts Dysplasia and Early-Stage Esophageal Adenocarcinoma, Based on a Delphi Process
Bennett C et al. – The authors developed a data–sifting platform and used the Delphi process to create evidence–based consensus statements for the management of patients with Barrett's esophagus (BE) and early–stage Esophageal adenocarcinoma (EA). This approach identified important clinical features of the diseases and areas for future studies.Methods
- The authors performed an international, multidisciplinary, systematic, evidence-based review of different management strategies for patients with BE and dysplasia or early-stage EA.
- They used a Delphi process to develop consensus statements.
- The results of literature searches were screened using a unique, interactive, Web-based data-sifting platform; THEY used 11,904 papers to inform the choice of statements selected.
- An a priori threshold of 80% agreement was used to establish consensus for each statement.
- Eighty-one of the 91 statements achieved consensus despite generally low quality of evidence, including 8 clinical statements:
- Specimens from endoscopic resection are better than biopsies for staging lesions
- It is important to carefully map the size of the dysplastic areas
- Patients that receive ablative or surgical therapy require endoscopic follow-up
- High-resolution endoscopy is necessary for accurate diagnosis
- Endoscopic therapy for HGD is preferred to surveillance
- Endoscopic therapy for HGD is preferred to surgery
- The combination of endoscopic resection and radiofrequency ablation is the most effective therapy
- After endoscopic removal of lesions from patients with HGD, all areas of BE should be ablated.