Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Am J Gastroenterol. 2022 Apr 1;117(4):559-587. doi: 10.14309/ajg.0000000000001680.
Barrett's esophagus (BE) is a common condition associated with chronic gastroesophageal reflux disease. BE is the only known precursor to esophageal adenocarcinoma, a highly lethal cancer with an increasing incidence over the last 5 decades. These revised guidelines implement Grading of Recommendations, Assessment, Development, and Evaluation methodology to propose recommendations for the definition and diagnosis of BE, screening for BE and esophageal adenocarcinoma, surveillance of patients with known BE, and the medical and endoscopic treatment of BE and its associated early neoplasia. Important changes since the previous iteration of this guideline include a broadening of acceptable screening modalities for BE to include nonendoscopic methods, liberalized intervals for surveillance of short-segment BE, and volume criteria for endoscopic therapy centers for BE. We recommend endoscopic eradication therapy for patients with BE and high-grade dysplasia and those with BE and low-grade dysplasia. We propose structured surveillance intervals for patients with dysplastic BE after successful ablation based on the baseline degree of dysplasia. We could not make recommendations regarding chemoprevention or use of biomarkers in routine practice due to insufficient data.
巴雷特食管（BE）是一种与慢性胃食管反流病相关的常见病症。BE 是食管腺癌唯一已知的前体，这种癌症具有高度致命性，在过去 50 年中发病率不断上升。这些修订后的指南采用了分级推荐评估、制定和评估方法，提出了 BE 和食管腺癌的定义和诊断、BE 和食管腺癌的筛查、已知 BE 患者的监测以及 BE 及其相关早期肿瘤的医疗和内镜治疗的建议。与本指南前一版本相比，重要的变化包括扩大了 BE 的可接受筛查方式，包括非内镜方法，放宽了短节段 BE 的监测间隔，以及 BE 内镜治疗中心的容积标准。我们建议对 BE 伴高级别异型增生和 BE 伴低级别异型增生的患者进行内镜消除治疗。我们建议根据基线异型增生程度，为成功消融后的异型增生 BE 患者制定结构化的监测间隔。由于数据不足，我们无法就化学预防或生物标志物在常规实践中的使用提出建议。
