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Gut 63:7-42 doi:10.1136/gutjnl-2013-305372
  • Guidelines

British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus

Editor's Choice
  1. John de Caestecker20
  1. 1MRC Cancer Unit, University of Cambridge, Cambridge, UK
  2. 2Nottingham Digestive Diseases Centre, NIHR Biomedical Research Unit, Queens Medical Centre, Nottingham University Hospitals NHS Trust
  3. 3GI Science Centre, University of Manchester, Salford Royal NHS Foundation Trust, Salford, UK
  4. 4Department of Gastroenterology, St George's Hospital, London, UK
  5. 5Department of Gastroenterology, Royal Victoria Hospital, Belfast, UK
  6. 6Department of Gastroenterology, Sandwell and West Birmingham Hospitals, Birmingham, UK
  7. 7Department of Gastroenterology, Southampton University Hospitals, Southampton, UK
  8. 8Department of Histopathology, University Hospitals NHS Trust, Nottingham, UK
  9. 9Department of Histopathology, South Warwickshire NHS Foundation Trust, Warwick, UK
  10. 10Department of Histopathology, Cambridge University Hospitals, Cambridge, UK
  11. 11Department of Gastroenterology, Oxford University Hospitals, Oxford, UK
  12. 12Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
  13. 13Plymouth University Peninsula, Schools of Medicine and Dentistry, Plymouth, UK
  14. 14Department of Surgery, Northumbria Healthcare NHS Foundation Trust, North Tyneside Hospital, North Shields, UK
  15. 15Department of Surgery, Nottingham University Hospitals, Nottingham, UK
  16. 16Department of Gastroenterology, University Hospital, Coventry, UK
  17. 17Department of Research Oncology, King's College, London, UK
  18. 18McMaster University, Hamilton, Ontario, Canada
  19. 19Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
  20. 20Digestive Diseases Centre, Leicester University Hospitals, Leicester, UK
  1. Correspondence to Professor Rebecca C Fitzgerald, MRC Cancer Unit, University of Cambridge, Box 197, Cambridge Biomedical Campus, Cambridge, CB2 0XZ, UK; rcf29{at}mrc-cu.cam.ac.uk
  • Received 31 May 2013
  • Revised 14 August 2013
  • Accepted 1 September 2013
  • Published Online First 28 October 2013

Abstract

These guidelines provide a practical and evidence-based resource for the management of patients with Barrett's oesophagus and related early neoplasia. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was followed to provide a methodological strategy for the guideline development. A systematic review of the literature was performed for English language articles published up until December 2012 in order to address controversial issues in Barrett's oesophagus including definition, screening and diagnosis, surveillance, pathological grading for dysplasia, management of dysplasia, and early cancer including training requirements. The rigour and quality of the studies was evaluated using the SIGN checklist system. Recommendations on each topic were scored by each author using a five-tier system (A+, strong agreement, to D+, strongly disagree). Statements that failed to reach substantial agreement among authors, defined as >80% agreement (A or A+), were revisited and modified until substantial agreement (>80%) was reached. In formulating these guidelines, we took into consideration benefits and risks for the population and national health system, as well as patient perspectives. For the first time, we have suggested stratification of patients according to their estimated cancer risk based on clinical and histopathological criteria. In order to improve communication between clinicians, we recommend the use of minimum datasets for reporting endoscopic and pathological findings. We advocate endoscopic therapy for high-grade dysplasia and early cancer, which should be performed in high-volume centres. We hope that these guidelines will standardise and improve management for patients with Barrett's oesophagus and related neoplasia.