TY - JOUR
T1 - Consensus statements for management of Barrett's dysplasia and early-stage esophageal adenocarcinoma, based on a delphi process
AU - Bennett, Cathy
AU - Vakil, Nimish
AU - Bergman, Jacques
AU - Harrison, Rebecca
AU - Odze, Robert
AU - Vieth, Michael
AU - Sanders, Scott
AU - Gay, Laura
AU - Pech, Oliver
AU - Longcroft-Wheaton, Gaius
AU - Romero, Yvonne
AU - Inadomi, John
AU - Tack, Jan
AU - Corley, Douglas A.
AU - Manner, Hendrik
AU - Green, Susi
AU - Al Dulaimi, David
AU - Ali, Haythem
AU - Allum, Bill
AU - Anderson, Mark
AU - Curtis, Howard
AU - Falk, Gary
AU - Fennerty, M. Brian
AU - Fullarton, Grant
AU - Krishnadath, Kausilia
AU - Meltzer, Stephen J.
AU - Armstrong, David
AU - Ganz, Robert
AU - Cengia, Gianpaolo
AU - Going, James J.
AU - Goldblum, John
AU - Gordon, Charles
AU - Grabsch, Heike
AU - Haigh, Chris
AU - Hongo, Michio
AU - Johnston, David
AU - Forbes-Young, Ricky
AU - Kay, Elaine
AU - Kaye, Philip
AU - Lerut, Toni
AU - Lovat, Laurence B.
AU - Lundell, Lars
AU - Mairs, Philip
AU - Shimoda, Tadakuza
AU - Spechler, Stuart
AU - Sontag, Stephen
AU - Malfertheiner, Peter
AU - Murray, Iain
AU - Nanji, Manoj
AU - Poller, David
AU - Ragunath, Krish
AU - Regula, Jaroslaw
AU - Cestari, Renzo
AU - Shepherd, Neil
AU - Singh, Rajvinder
AU - Stein, Hubert J.
AU - Talley, Nicholas J.
AU - Galmiche, Jean Paul
AU - Tham, Tony C.K.
AU - Watson, Peter
AU - Yerian, Lisa
AU - Rugge, Massimo
AU - Rice, Thomas W.
AU - Hart, John
AU - Gittens, Stuart
AU - Hewin, David
AU - Hochberger, Juergen
AU - Kahrilas, Peter
AU - Preston, Sean
AU - Sampliner, Richard
AU - Sharma, Prateek
AU - Stuart, Robert
AU - Wang, Kenneth
AU - Waxman, Irving
AU - Abley, Chris
AU - Loft, Duncan
AU - Penman, Ian
AU - Shaheen, Nicholas J.
AU - Chak, Amitabh
AU - Davies, Gareth
AU - Dunn, Lorna
AU - Falck-Ytter, Yngve
AU - Decaestecker, John
AU - Bhandari, Pradeep
AU - Ell, Christian
AU - Griffin, S. Michael
AU - Attwood, Stephen
AU - Barr, Hugh
AU - Allen, John
AU - Ferguson, Mark K.
AU - Moayyedi, Paul
AU - Jankowski, Janusz A.Z.
N1 - Funding Information:
Conflicts of interest These authors disclose the following: Janusz Jankowski is a paid consultant to AstraZeneca UK and Almirall and a grant holder from FALK . He is Chief Investigator for the AspECT and CHoPIN trials, which are supported by AstraZeneca. Cathy Bennett is the proprietor of Systematic Research Ltd and received a consultancy fee for her work on this consensus document. Paul Moayyedi is a consultant to AstraZeneca. Nimish Vakil is a consultant to Astra Zeneca, Takeda, Ironwood, Restech, and Orexo. Robert Ganz is the primary inventor and the cofounder of BÂRRX Medical, holds equity in the company, and serves as a paid consultant. Peter Kahrilas performs ad hoc consulting for AstraZeneca, Eisai, EndoGastric Solutions, and Ironwood, and serves on advisory boards for Torax and Reckitt Benckiser. Michio Hongo is a consultant to Abbott Japan, AstraZeneca Japan, AstellasPharma, Daiichi-Sankyo, Dainippon Sumitomo Pharma, Eisai, Kissei Pharmaceutical, Takeda Pharmaceutical, Scampo Pharma, and Zelia Pharmaceutical. Yvonne Romero is a consultant to AstraZeneca, Santarus, Takeda, Kala, Pfizer, and Aptalis. David Armstrong has received one or more of the following: educational and research grants, honoraria, consulting fees, and related travel expenses from Abbott Laboratories , AltanaPharma , AstraZeneca , Axcan , Eisai Limited , Gilead , Janssen Ortho Inc , Merck , NPS Pharmaceuticals , Nycomed , Olympus Canada Inc , Pentax Medical Inc , Pfizer , Proctor & Gamble , Schering-Plough , Shire Canada , Takeda Canada , Warner-Chilcott , and XenoPort Inc . Richard Sampliner received a BÂRRX research grant. Oliver Pech is a consultant to Hitachi Medical, Fujinon, Norgine, and AstraZeneca. Jaroslaw Regula is a consultant to Abbott, Astellas, AstraZeneca, Krka, MSD, Polpharma, Sandoz, and Warner-Chilcott.M. Brian Fennerty is a consultant for Aptalis, Oncoscope, and Meridian Bioscience. Nicholas Talley has had grant support from Falk , Forest , Janssen , and Takeda, has been a consultant for ARYx, Astellas, Astra Zeneca, Boehringer Ingleheim, Care Capitol, ConCERT, Edusa, Falk, Focus Medical Communications, Forest, Ironwood, Janssen, Johnson & Johnson, Meritage, NicOx, Novartis, Prometheus, Salix, Sanofi-Adventis, Shire, Tranzyme, Theravance, XenoPort, and Zeria, and is a key opinion leader for Doyen Medical Inc. John de Caestecker is Chair of AspECT Trial Management Group, which is AstraZeneca supported. Jacques Bergman is a consultant for Boston Scientific and has research support from BÂRRX Medical, Olympus, and Cook. Stephen Attwood is on the aspect trial management committee, which is AstraZeneca supported. JeanPaul Galmiche is a consultant and speaker for Given Imaging, Mauna Kea Technologies, Shire, Norgine, and Xenoport. His institution has received research grants from AstraZeneca , Janssen Cilag France , ADDEX , and Pentax . Laurence Lovat is on the Advisory Board of Ninepoint Medical and performed ad hoc consulting for Given Imaging and research support for Axcan Pharma, DUSA Pharmaceuticals, and BÂRRX. Peter Watson is a member of AspECT Trial Management Group, which is AstraZeneca sponsored. Kenneth Wang is a consultant to BÂRRX, Ironwood Pharma, CDX Diagnostics, Pinnacle Pharma, and CSA. David Johnston has received speaker's fees and support to attend educational meetings from AstraZeneca. Krish Ragunath received research support, educational grants and speaker honoraria from Olympus Keymed , Cook Medical and BÂRRX Medical . Stuart Gittens is managing director of ECD solutions web data handling company. The remaining authors disclose no conflicts.
PY - 2012/8
Y1 - 2012/8
N2 - Background & Aims: Esophageal adenocarcinoma (EA) is increasingly common among patients with Barrett's esophagus (BE). We aimed to provide consensus recommendations based on the medical literature that clinicians could use to manage patients with BE and low-grade dysplasia, high-grade dysplasia (HGD), or early-stage EA. Methods: We performed an international, multidisciplinary, systematic, evidence-based review of different management strategies for patients with BE and dysplasia or early-stage EA. We used a Delphi process to develop consensus statements. The results of literature searches were screened using a unique, interactive, Web-based data-sifting platform; we used 11,904 papers to inform the choice of statements selected. An a priori threshold of 80% agreement was used to establish consensus for each statement. Results: Eighty-one of the 91 statements achieved consensus despite generally low quality of evidence, including 8 clinical statements: (1) specimens from endoscopic resection are better than biopsies for staging lesions, (2) it is important to carefully map the size of the dysplastic areas, (3) patients that receive ablative or surgical therapy require endoscopic follow-up, (4) high-resolution endoscopy is necessary for accurate diagnosis, (5) endoscopic therapy for HGD is preferred to surveillance, (6) endoscopic therapy for HGD is preferred to surgery, (7) the combination of endoscopic resection and radiofrequency ablation is the most effective therapy, and (8) after endoscopic removal of lesions from patients with HGD, all areas of BE should be ablated. Conclusions: We developed a data-sifting platform and used the Delphi process to create evidence-based consensus statements for the management of patients with BE and early-stage EA. This approach identified important clinical features of the diseases and areas for future studies.
AB - Background & Aims: Esophageal adenocarcinoma (EA) is increasingly common among patients with Barrett's esophagus (BE). We aimed to provide consensus recommendations based on the medical literature that clinicians could use to manage patients with BE and low-grade dysplasia, high-grade dysplasia (HGD), or early-stage EA. Methods: We performed an international, multidisciplinary, systematic, evidence-based review of different management strategies for patients with BE and dysplasia or early-stage EA. We used a Delphi process to develop consensus statements. The results of literature searches were screened using a unique, interactive, Web-based data-sifting platform; we used 11,904 papers to inform the choice of statements selected. An a priori threshold of 80% agreement was used to establish consensus for each statement. Results: Eighty-one of the 91 statements achieved consensus despite generally low quality of evidence, including 8 clinical statements: (1) specimens from endoscopic resection are better than biopsies for staging lesions, (2) it is important to carefully map the size of the dysplastic areas, (3) patients that receive ablative or surgical therapy require endoscopic follow-up, (4) high-resolution endoscopy is necessary for accurate diagnosis, (5) endoscopic therapy for HGD is preferred to surveillance, (6) endoscopic therapy for HGD is preferred to surgery, (7) the combination of endoscopic resection and radiofrequency ablation is the most effective therapy, and (8) after endoscopic removal of lesions from patients with HGD, all areas of BE should be ablated. Conclusions: We developed a data-sifting platform and used the Delphi process to create evidence-based consensus statements for the management of patients with BE and early-stage EA. This approach identified important clinical features of the diseases and areas for future studies.
KW - BADCAT
KW - Esophageal Cancer
KW - Systematic Analysis
KW - Treatment Strategy
UR - http://www.scopus.com/inward/record.url?scp=84864192459&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84864192459&partnerID=8YFLogxK
U2 - 10.1053/j.gastro.2012.04.032
DO - 10.1053/j.gastro.2012.04.032
M3 - Article
C2 - 22537613
AN - SCOPUS:84864192459
SN - 0016-5085
VL - 143
SP - 336
EP - 346
JO - Gastroenterology
JF - Gastroenterology
IS - 2
ER -