INTRODUCTION

These guidelines have developed as a joint project between the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, the British Society of Gastroenterology, and the British Association of Surgical Oncology. They have been produced as part of the wider initiative of the British Society of Gastroenterology to provide guidance for clinicians in several areas of clinical practice related to the broad field of gastroenterology.

Over the past 10 years there have been many significant changes in the management of oesophageal and gastric cancer. Both diseases have shown remarkable changes in epidemiology with a concentration of tumours adjacent to the oesophagogastric junction. Advances in established investigative techniques and developments in new technology have radically altered the way in which the two diseases can be assessed without the need for surgery. Greater understanding of the natural history has significantly influenced the approach to diagnosis and to treatment options. Appreciation of the fundamental need for multidisciplinary treatment planning has reflected greater recognition by all interested clinicians of the role of the various treatment modalities. The essential role of best supportive care has significantly evolved emphasising the need for a holistic approach to all patients.

These guidelines have been written to emphasise these recent developments and to place them in the context of established approaches to enable clinicians to incorporate them into their clinical practice. They have not been written, nor are they intended, to be prescriptive, as such an approach would interfere with clinical judgement. However, they have been produced based on careful review of the available evidence with the recommendations weighted according to the strength of the evidence. As with other similar recommendations, much of the evidence is based on consensus view as in many areas scientific evaluation has not taken place or is not possible. Such limitations are inevitable …