Gastroenterology Division, Universidad de La Sabana, Chía, Colombia; Advanced GI Endoscopy, EmuraCenter LatinoAmerica, Bogotá DC, Colombia.
Division of Gastroenterology, VA Medical Center and University of Kansas School of Medicine, Kansas City, Missouri.
Gastroenterology. 2022 Jul;163(1):84-96.e2. doi: 10.1053/j.gastro.2022.03.022. Epub 2022 Mar 23.
BACKGROUND & AIMS: Despite the significant advances made in the diagnosis and treatment of Barrett's esophagus (BE), there is still a need for standardized definitions, appropriate recognition of endoscopic landmarks, and consistent use of classification systems. Current controversies in basic definitions of BE and the relative lack of anatomic knowledge are significant barriers to uniform documentation. We aimed to provide consensus-driven recommendations for uniform reporting and global application.
The World Endoscopy Organization Barrett's Esophagus Committee appointed leaders to develop an evidence-based Delphi study. A working group of 6 members identified and formulated 23 statements, and 30 internationally recognized experts from 18 countries participated in 3 rounds of voting. We defined consensus as agreement by ≥80% of experts for each statement and used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool to assess the quality of evidence and the strength of recommendations.
After 3 rounds of voting, experts achieved consensus on 6 endoscopic landmarks (palisade vessels, gastroesophageal junction, squamocolumnar junction, lesion location, extraluminal compressions, and quadrant orientation), 13 definitions (BE, hiatus hernia, squamous islands, columnar islands, Barrett's endoscopic therapy, endoscopic resection, endoscopic ablation, systematic inspection, complete eradication of intestinal metaplasia, complete eradication of dysplasia, residual disease, recurrent disease, and failure of endoscopic therapy), and 4 classification systems (Prague, Los Angeles, Paris, and Barrett's International NBI Group). In round 1, 18 statements (78%) reached consensus, with 12 (67%) receiving strong agreement from more than half of the experts. In round 2, 4 of the remaining statements (80%) reached consensus, with 1 statement receiving strong agreement from 50% of the experts. In the third round, a consensus was reached on the remaining statement.
We developed evidence-based, consensus-driven statements on endoscopic landmarks, definitions, and classifications of BE. These recommendations may facilitate global uniform reporting in BE.
尽管 Barrett 食管（BE）的诊断和治疗取得了重大进展，但仍需要标准化的定义、对内镜标志的适当识别以及分类系统的一致使用。BE 的基本定义存在争议，且相对缺乏解剖学知识，这是统一文件记录的重大障碍。我们旨在提供一致的报告和全球应用共识驱动的建议。
世界内镜组织 Barrett 食管委员会任命负责人制定一项基于证据的 Delphi 研究。一个由 6 名成员组成的工作组确定并制定了 23 项声明，来自 18 个国家的 30 名国际公认专家参加了 3 轮投票。我们将共识定义为每个声明获得≥80%的专家同意，并使用推荐分级、评估、发展与评价（GRADE）工具来评估证据质量和建议强度。
经过 3 轮投票，专家们就 6 个内镜标志（栅栏血管、胃食管交界处、鳞柱状交界、病变位置、腔外压迫和象限定向）、13 个定义（BE、食管裂孔疝、鳞柱交界、柱状岛、Barrett 内镜治疗、内镜切除、内镜消融、系统检查、肠上皮化生完全消除、异型增生完全消除、残留病变、复发疾病和内镜治疗失败）和 4 个分类系统（布拉格、洛杉矶、巴黎和 Barrett 国际窄带成像组）达成共识。在第 1 轮中，18 项声明（78%）达成共识，其中 12 项（67%）获得超过一半专家的强烈一致同意。在第 2 轮中，其余 4 项声明中有 4 项（80%）达成共识，其中 1 项声明获得 50%专家的强烈一致同意。在第 3 轮中，就其余声明达成了共识。
我们制定了基于证据、共识驱动的 BE 内镜标志、定义和分类声明。这些建议可能有助于在 BE 中实现全球统一报告。
