Wani Sachin, Zhou Margaret J, Sawas Tarek, Rubenstein Joel H, Eluri Swathi, Leiman David A, Sultan Shahnaz, Singh Siddharth, Inadomi John, Thrift Aaron P, Katzka David A, Davitkov Perica
Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California.
Gastroenterology. 2025 Nov;169(6):1184-1231. doi: 10.1053/j.gastro.2025.09.012.
BACKGROUND & AIMS: Barrett's esophagus (BE) is the only identifiable precursor to esophageal adenocarcinoma (EAC). Endoscopic surveillance has been proposed for early detection of BE-related neoplasia and reducing EAC mortality. This clinical practice guideline aims to inform clinicians and patients by providing evidence-based practice recommendations for surveillance in patients with BE.
The Grading of Recommendations Assessment, Development and Evaluation framework was used to assess evidence and make recommendations. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients, conducted an evidence review, and used the Evidence-to-Decision Framework to develop recommendations regarding the role of endoscopic surveillance in patients with BE. The clinical domains addressed included: (1) overall role of endoscopic surveillance, (2) surveillance in patients with columnar-lined esophagus <1 cm, (3) optimal imaging modalities, (4) adjunctive sampling techniques, (5) the utility of biomarkers in risk-stratification, (6) chemopreventive strategies, and (7) antireflux procedures in the prevention of progression in patients with BE. Clinical recommendations were based on the balance between the desirable and undesirable effects, patient values, costs, and health equity considerations.
The panel agreed on 8 recommendations. Based on the available evidence, the panel provided a conditional recommendation in favor of surveillance for patients with nondysplastic BE. In patients with columnar-lined esophagus <1 cm, a conditional recommendation was made against endoscopic surveillance. The panel made a strong recommendation in favor of a combination of high-definition white light endoscopy and chromoendoscopy compared with white light endoscopy alone. The panel made no recommendation on the use of enhanced sampling techniques, such as wide-area transepithelial sampling to enhance neoplasia detection and biomarkers such as p53 and TissueCypher to predict progression in BE. The panel provided a conditional recommendation for the use of daily proton pump inhibitor therapy compared with no therapy and compared with antireflux surgery to prevent progression in BE.
This document provides a comprehensive outline on the role of surveillance in patients with BE. Key implementation statements included in this document stress the importance of a high-quality endoscopy examination, sampling using a structured biopsy protocol, and confirming the diagnosis of BE-related neoplasia by an expert pathologist. This document also provides guidance on surveillance intervals and management of patients with BE-related low-grade dysplasia and indefinite for dysplasia. Providers should engage in shared decision making based on patient preferences. Limitations and gaps in the evidence are highlighted to guide future research opportunities.
This guideline is endorsed by the Canadian Association of Gastroenterology.
巴雷特食管（BE）是食管腺癌（EAC）唯一可识别的癌前病变。已提出内镜监测以早期发现BE相关肿瘤并降低EAC死亡率。本临床实践指南旨在通过为BE患者的监测提供循证实践建议，为临床医生和患者提供信息。
采用推荐分级评估、制定与评价框架来评估证据并提出建议。专家组根据临床问题和结果对临床医生和患者的重要性进行排序，进行证据审查，并使用证据到决策框架来制定关于内镜监测在BE患者中的作用的建议。涉及的临床领域包括：（1）内镜监测的总体作用；（2）柱状上皮化生食管长度<1 cm患者的监测；（3）最佳成像方式；（4）辅助采样技术；（5）生物标志物在风险分层中的作用；（6）化学预防策略；（7）抗反流手术在预防BE患者病情进展中的作用。临床建议基于期望效果与不良效果、患者价值观、成本和健康公平性考虑之间的平衡。
专家组达成了8项建议。基于现有证据，专家组给出了一项有条件的建议，支持对无异型增生的BE患者进行监测。对于柱状上皮化生食管长度<1 cm的患者，给出了一项有条件的建议，反对进行内镜监测。与单纯白光内镜相比，专家组强烈建议采用高清白光内镜和色素内镜相结合的方式。对于使用增强采样技术（如广域经上皮采样以提高肿瘤检测率）以及使用p53和TissueCypher等生物标志物来预测BE进展，专家组未给出建议。与不进行治疗以及与抗反流手术相比，专家组给出了一项有条件的建议，支持使用每日质子泵抑制剂治疗以预防BE进展。
本文档提供了关于监测在BE患者中的作用的全面概述。本文档中包含的关键实施声明强调了高质量内镜检查、使用结构化活检方案进行采样以及由专家病理学家确认BE相关肿瘤诊断的重要性。本文档还为BE相关低级别异型增生和异型增生不确定的患者的监测间隔和管理提供了指导。医疗服务提供者应根据患者偏好进行共同决策。突出了证据中的局限性和差距，以指导未来的研究机会。
本指南得到了加拿大胃肠病学会的认可。
