Диагностика и ведение пищевода Барретта

ESGE suggests a proton pump inhibitor (standard dose once daily) for chemoprevention in patients with BE.

ESGE recommends against the use of aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) for chemoprevention.

ESGE recommends against screening for BE in an unselected population.

ESGE suggests that case finding for BE could be considered in a select population, consisting of patients ≥ 50 years of age with a history of chronic GERD symptoms, and at least one of the following risk factors (white ethnicity, male sex, obesity, smoking, having a first-degree relative with BE or EAC).

ESGE recommends that a swallowable nonendoscopic cell collection device such as the Cytosponge, combined with a cytopathologic assessment and biomarker Trefoil-factor 3 (TFF3) can be used as an alternative to endoscopy for case finding of BE. Other nonendoscopic technologies cannot yet be recommended.

ESGE recommends the use of high definition endoscopy for endoscopic surveillance of BE.

ESGE suggests the use of chromoendoscopy (acetic acid and/or virtual chromoendoscopy) for endoscopic surveillance of BE.

ESGE recommends the following standards for BE surveillance: a minimum of 1-minute inspection time per cm of BE length; 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.

ESGE does not recommend the use of nonendoscopic tools (swallowable cell collecting devices or blood-based biomarkers) for the surveillance of BE.

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.

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.

ESGE recommends the use of p53 immunohistochemistry to support reproducibility of dysplasia diagnosis and aid the assessment of atypia of uncertain significance.

ESGE suggests that brushing techniques such as WATS 3D should not be routinely used as an alternative for, or adjunct method to, conventional biopsies for tissue collection during endoscopic BE surveillance.

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.

ESGE recommends endoscopic ablation treatment for BE with confirmed HGD without visible lesions, to prevent progression to invasive cancer.

ESGE recommends offering complete eradication of all remaining Barrett epithelium by ablation after endoscopic resection of visible abnormalities containing any degree of dysplasia or EAC.

ESGE recommends the use of endoscopic mucosal resection (EMR) for ≤ 20-mm visible lesions with low probability of submucosal invasion (Paris type 0-IIa, 0-IIb) and for larger or multifocal benign (dysplastic) lesions.

ESGE suggests the use of endoscopic submucosal dissection (ESD) for lesions suspicious for submucosal invasion (Paris type 0-Is, 0-IIc), for malignant lesions of > 20 mm, and for lesions in scarred/fibrotic areas.

ESGE recommends endoscopic resection as curative treatment for T1a Barrett's cancer with well/moderate differentiation and no signs of (lympho)vascular invasion.

ESGE suggests that low risk submucosal (T1b) esophageal adenocarcinoma (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)/positron emission tomography-computed tomography (PET-CT) is performed in expert centers.

ESGE suggests that mucosal (T1a) esophageal adenocarcinoma with (lympho)vascular invasion and/or poor tumor differentiation should be considered as 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.

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.

ESGE recommends adequate acid suppression treatment during and after endoscopic eradication therapy of BE.

ESGE recommends that the first endoscopic follow-up after successful EET of BE is performed in an expert center.

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.

ESGE recommends against routine four-quadrant biopsies of neo-squamous epithelium after successful EET of BE.

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.

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.

After successful EET, ESGE recommends: (a) using the term "recurrence of BE" where there is endoscopic evidence of columnar epithelium in the tubular esophagus — intestinal metaplasia in a normal-appearing neo-squamocolumnar junction should not be considered recurrence of BE; (b) using the term "recurrence of dysplasia" where biopsies show low or high grade dysplasia, and "recurrence of cancer" where biopsies show cancer.

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.