Australian clinical practice guidelines for the diagnosis and management of Barrett's esophagus and early esophageal adenocarcinoma

Abstract

Barrett’s esophagus (BE), a common condition, is the only known precursor to esophageal adenocarcinoma (EAC). There is uncertainty about the best way to manage BE as most people with BE never develop EAC and most patients diagnosed with EAC have no preceding diagnosis of BE. Moreover, there have been recent advances in knowledge and practice about the management of BE and early EAC. To aid clinical decision making in this rapidly moving field, Cancer Council Australia convened an expert working party to identify pertinent clinical questions. The questions covered a wide range of topics including endoscopic and histological definitions of BE and early EAC; prevalence, incidence, natural history, and risk factors for BE; and methods for managing BE and early EAC. The latter considered modification of lifestyle factors; screening and surveillance strategies; and medical, endoscopic, and surgical interventions. To answer each question, the working party systematically reviewed the literature and developed a set of recommendations through consensus. Evidence underpinning each recommendation was rated according to quality and applicability. Author contributions: Davic C Whiteman, Mark Appleyard, Farzan Fahrtash Bahin, Yuri V Bobryshev, Michael J Bourke, Ian Brown, Adrian Chung, Andrew Clouston, John Emery, Guy D Eslick, Louisa G Gordon, Florian Grimpen, Geoff Hebbard, Luke Hourigan, Bradley J Kendall, Eric Y T Lee, Angelique Levert, Reginald V Lord, Sarah J Lord, Alan Moss, Ian Norton, Darren Pavey, Spiro Raftopoulos, Shan Rajendra, Mark Schoeman, Rajvinder Singh, Freddy Sitas, Mark Smithers, Andrew Taylor, Melissa L Thomas, Iain Thomson, Henry To, David I Watson, and Ian F Yusoff reviewed the literature and compiled the evidence summaries. Emma Dickins and Laura Holliday conducted systematic literature searches, screened the primary literature, and collated the evidence summaries. Jutta von Dincklage and Christine Vuletich managed the guideline development process and provided project governance. Ian Olver provided oversight and funding and Derek Maule provided consumer input. All authors were involved in drafting and critical revision of the manuscript.