Clinical practice guidelines for the diagnosis and management of Barrett’s Oesophagus and Early Oesophageal Adenocarcinoma

Cite this guideline

Cancer Council Australia Barrett's Oesophagus Guidelines Working Party. Clinical practice guidelines for the diagnosis and management of Barrett’s Oesophagus and Early Oesophageal Adenocarcinoma. Sydney: Cancer Council Australia. [Version URL: https://wiki.cancer.org.au/australiawiki/index.php?oldid=213563, cited 2022 Jan 17]. Available from: https://wiki.cancer.org.au/australia/Guidelines:Barrett%27s.

This resource has been developed, reviewed or revised more than five years ago. It may no longer reflect current evidence or best practice.

Published: 2014

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Cancer Council Australia Barrett’s Oesophagus and Early Oesophageal Adenocarcinoma Working Party. Australian clinical practice guidelines for the diagnosis and management of Barrett's esophagus and early esophageal adenocarcinoma J Gastroenterol Hepatol. 2015 May;30(5):804-20. doi: 10.1111/jgh.12913.

Further resources for health professionals Decision tree for the management of Barrett’s Oesophagus

Contents

Foreword

Summary of recommendations

Barrett's Oesophagus without Dysplasia

Natural History

• What is the prevalence of BO in the Australian population in comparison with other populations?
• Which factors best predict the risk of developing BO?
• What is the incidence of neoplasia in patients with BO?
• What are the risk factors for progression from non-dysplastic BO to high-grade dysplasia or adenocarcinoma?

Referral

• For which populations is screening for BO cost-effective?

Diagnosis/Definition

• What is the endoscopic definition of BO and how is it described?
• What is the optimal tissue sampling at endoscopy for diagnosis of BO?
• What is the histological definition of BO?

Management

• Are there any medical or surgical interventions that cause regression of BO?
• Are there any treatments that prevent progression of BO to cancer?
• What is appropriate medical systemic therapy for symptoms associated with BO?
• Is there a role for ablative therapy to treat BO?

Surveillance and Follow-up

• How frequently should patients with BO undergo endoscopy?
• Are there groups of patients with non-dysplastic BO that require more frequent surveillance?
• Are there groups of patients with BO that can be discharged from surveillance?
• Is surveillance cost-effective for follow-up of patients with BO?

Barrett's Oesophagus with Dysplasia and/or Adenocarcinoma

Definition and Diagnosis

• What are the endoscopic features of neoplasia (dysplasia and early cancer) within a BO segment?

• What is the histological definition and grading of dysplasia in patients with BO?

• What are the histological features of early adenocarcinoma of the oesophagus?
• What are the best modalities for accurately staging early oesophageal adenocarcinoma?

Biomarkers

• Are there biomarkers for the diagnosis (presence) of BO?

Management

Low grade dysplasia

• What is the appropriate management of low grade dysplasia in patients with BO?

High grade dysplasia and early cancer

• What are the goals of treatment of high grade dysplasia in patients with BO?

• What is the best endoscopic treatment for high grade dysplasia in patients with BO?

• After successful endoscopic treatment for BO neoplasia, how frequently should patients undergo endoscopy?

• What is the best endoscopic management of early oesophageal adenocarcinoma?

• What endoscopic surveillance protocol should be followed for patients with BO and high grade dysplasia?

• How effective is endoscopic management compared with surgical management for high grade dysplasia in patients with BO?

Appendices

Guideline development process

Working party members and contributors

Competing interest register

Abbreviations