Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of Gastroenterology and Hepatology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
Endoscopy. 2023 Dec;55(12):1124-1146. doi: 10.1055/a-2176-2440. Epub 2023 Oct 9.
MR1 : ESGE recommends the following standards for Barrett esophagus (BE) surveillance:- a minimum of 1-minute inspection time per cm of BE length during a surveillance endoscopy- photodocumentation of landmarks, the BE segment including one picture per cm of BE length, and the esophagogastric junction in retroflexed position, and any visible lesions- use of the Prague and (for visible lesions) Paris classification- collection of biopsies from all visible abnormalities (if present), followed by random four-quadrant biopsies for every 2-cm BE length.Strong recommendation, weak quality of evidence. MR2: ESGE suggests varying surveillance intervals for different BE lengths. For BE with a maximum extent of ≥ 1 cm and < 3 cm, BE surveillance should be repeated every 5 years. For BE with a maximum extent of ≥ 3 cm and < 10 cm, the interval for endoscopic surveillance should be 3 years. Patients with BE with a maximum extent of ≥ 10 cm should be referred to a BE expert center for surveillance endoscopies. For patients with an irregular Z-line/columnar-lined esophagus of < 1 cm, no routine biopsies or endoscopic surveillance are advised.Weak recommendation, low quality of evidence. MR3: ESGE suggests that, if a patient has reached 75 years of age at the time of the last surveillance endoscopy and/or the patient's life expectancy is less than 5 years, the discontinuation of further surveillance endoscopies can be considered. Weak recommendation, very low quality of evidence. MR4: ESGE recommends offering endoscopic eradication therapy using ablation to patients with BE and low grade dysplasia (LGD) on at least two separate endoscopies, both confirmed by a second experienced pathologist.Strong recommendation, high level of evidence. MR5: ESGE recommends endoscopic ablation treatment for BE with confirmed high grade dysplasia (HGD) without visible lesions, to prevent progression to invasive cancer.Strong recommendation, high level of evidence. MR6: ESGE recommends offering complete eradication of all remaining Barrett epithelium by ablation after endoscopic resection of visible abnormalities containing any degree of dysplasia or esophageal adenocarcinoma (EAC).Strong recommendation, moderate quality of evidence. MR7: ESGE recommends endoscopic resection as curative treatment for T1a Barrett's cancer with well/moderate differentiation and no signs of lymphovascular invasion.Strong recommendation, high level of evidence. MR8: ESGE suggests that low risk submucosal (T1b) EAC (i. e. submucosal invasion depth ≤ 500 µm AND no [lympho]vascular invasion AND no poor tumor differentiation) can be treated by endoscopic resection, provided that adequate follow-up with gastroscopy, endoscopic ultrasound (EUS), and computed tomography (CT)/positrion emission tomography-computed tomography (PET-CT) is performed in expert centers.Weak recommendation, low quality of evidence. MR9: ESGE suggests that submucosal (T1b) esophageal adenocarcinoma with deep submucosal invasion (tumor invasion > 500 µm into the submucosa), and/or (lympho)vascular invasion, and/or a poor tumor differentiation should be considered high risk. Complete staging and consideration of additional treatments (chemotherapy and/or radiotherapy and/or surgery) or strict endoscopic follow-up should be undertaken on an individual basis in a multidisciplinary discussion.Strong recommendation, low quality of evidence. MR10 A: ESGE recommends that the first endoscopic follow-up after successful endoscopic eradication therapy (EET) of BE is performed in an expert center.Strong recommendation, very low quality of evidence. B: ESGE recommends careful inspection of the neo-squamocolumnar junction and neo-squamous epithelium with high definition white-light endoscopy and virtual chromoendoscopy during post-EET surveillance, to detect recurrent dysplasia.Strong recommendation, very low level of evidence. C: ESGE recommends against routine four-quadrant biopsies of neo-squamous epithelium after successful EET of BE.Strong recommendation, low level of evidence. D: ESGE suggests, after successful EET, obtaining four-quadrant random biopsies just distal to a normal-appearing neo-squamocolumnar junction to detect dysplasia in the absence of visible lesions.Weak recommendation, low level of evidence. E: ESGE recommends targeted biopsies are obtained where there is a suspicion of recurrent BE in the tubular esophagus, or where there are visible lesions suspicious for dysplasia.Strong recommendation, very low level of evidence. MR11: After successful EET, ESGE recommends the following surveillance intervals:- For patients with a baseline diagnosis of HGD or EAC:at 1, 2, 3, 4, 5, 7, and 10 years after last treatment, after which surveillance may be stopped.- For patients with a baseline diagnosis of LGD:at 1, 3, and 5 years after last treatment, after which surveillance may be stopped.Strong recommendation, low quality of evidence.
MR1:ESGE 建议以下 Barrett 食管(BE)监测标准:- 在监测内镜检查中,每厘米 BE 长度至少检查 1 分钟- 记录地标、包括每厘米 BE 长度的一张图片在内的 BE 段以及胃食管交界处的反向位置以及任何可见病变- 使用布拉格和(可见病变)巴黎分类- 从所有可见异常(如果存在)采集活检,然后每隔 2 厘米 BE 长度采集四个象限的随机活检。强烈推荐,证据质量低。MR2:ESGE 建议根据不同的 BE 长度调整监测间隔。对于最大长度≥1cm 且<3cm 的 BE,应每 5 年重复进行 BE 监测。对于最大长度≥3cm 且<10cm 的 BE,内镜监测间隔应为 3 年。最大长度≥10cm 的 BE 患者应转介至 BE 专家中心进行监测内镜检查。对于最大长度<1cm 的不规则 Z 线/柱状上皮食管,不建议常规进行活检或内镜监测。弱推荐,证据质量低。MR3:ESGE 建议,如果患者在上一次监测内镜检查时已经达到 75 岁,或者患者的预期寿命不足 5 年,则可以考虑停止进一步的监测内镜检查。弱推荐,极低质量的证据。MR4:ESGE 建议对至少两次内镜检查中均确认存在低级别异型增生(LGD)的 BE 患者,提供使用消融进行内镜下消除治疗。强烈推荐,高质量证据。MR5:ESGE 建议对无可见病变的 BE 伴高级别异型增生(HGD)进行内镜消融治疗,以防止进展为浸润性癌症。强烈推荐,高质量证据。MR6:ESGE 建议在切除包含任何程度异型增生或食管腺癌(EAC)的可见异常后,通过消融完全消除所有剩余的 Barrett 上皮。强烈推荐,中高质量证据。MR7:ESGE 建议对 T1a 期 Barrett 癌,分化良好/中度,无脉管侵犯迹象的患者,进行内镜下切除作为治愈性治疗。强烈推荐,高质量证据。MR8:ESGE 建议对于低风险的黏膜下(T1b)EAC(即黏膜下浸润深度≤500μm,且无[淋巴]血管侵犯和低分化),可以进行内镜下切除,如果在专家中心进行充分的随访,包括胃镜、内镜超声(EUS)和计算机断层扫描(CT)/正电子发射断层扫描-计算机断层扫描(PET-CT)。弱推荐,低质量证据。MR9:ESGE 建议对于黏膜下(T1b)EAC,浸润深度>500μm 进入黏膜下层,以及/或(淋巴)血管侵犯,以及/或分化差的患者,应考虑为高危。应根据个体情况,在多学科讨论中进行全面分期,并考虑其他治疗方法(化疗和/或放疗和/或手术)或严格的内镜随访。强烈推荐,低质量证据。MR10 A:ESGE 建议在成功进行 BE 的内镜下消除治疗(EET)后,在专家中心进行首次内镜随访。强烈推荐,极低质量证据。B:ESGE 建议在 EET 后监测中,仔细检查新的鳞状柱状交界处和新的鳞状上皮,使用高清晰度白光内镜和虚拟染色内镜,以检测复发性异型增生。强烈推荐,极低水平的证据。C:ESGE 建议在 BE 的 EET 成功后,不常规进行新的鳞状上皮的四个象限活检。强烈推荐,低水平的证据。D:ESGE 建议在 EET 成功后,在正常表现的新鳞状柱状交界处远端获得四个象限的随机活检,以在没有可见病变的情况下检测异型增生。弱推荐,低水平的证据。E:ESGE 建议在怀疑管状食管中存在复发性 BE 或存在可疑异型增生的可见病变时,进行靶向活检。强烈推荐,极低水平的证据。MR11:在成功进行 EET 后,ESGE 建议以下监测间隔:- 对于基线诊断为 HGD 或 EAC 的患者:在最后一次治疗后 1、2、3、4、5、7 和 10 年进行,此后监测可以停止。- 对于基线诊断为 LGD 的患者:在最后一次治疗后 1、3 和 5 年进行,此后监测可以停止。强烈推荐,低质量证据。
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