British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus
British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus
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DOI：
10.1136/gutjnl-2013-305372
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发表时间：
2014-01-01
期刊：
影响因子：
24.5
通讯作者：
de Caestecker, John
中科院分区：
文献类型：
--
作者：
Fitzgerald, Rebecca C.;di Pietro, Massimiliano;de Caestecker, John
这些指南提供了一个实用的和循证的资源与巴雷特食管和相关的早期肿瘤患者的管理。遵循研究和评价指南评估（AGREE II）工具，为指南制定提供方法策略。对截至2012年12月发表的英文文献进行了系统性文献综述，以解决Barrett食管中存在争议的问题，包括定义、筛查和诊断、监测、异型增生的病理分级、异型增生的管理和早期癌症（包括培训要求）。使用SIGN检查表系统评估研究的严谨性和质量。每个作者对每个主题的建议都使用五级系统进行评分（A+，非常同意，D+，非常不同意）。对作者之间未能达成实质性一致的声明（定义为>80%的一致性（A或A+））进行重新审查和修改，直至达成实质性一致（>80%）。在制定这些指南时，我们考虑了人口和国家卫生系统的利益和风险，以及患者的观点。我们首次建议根据患者的临床和组织病理学标准，根据其估计的癌症风险对患者进行分层。为了改善临床医生之间的沟通，我们建议使用最小数据集来报告内镜和病理结果。我们提倡高度异型增生和早期癌症的内镜治疗，这应该在高容量中心进行。我们希望这些指南能帮助和改善巴雷特食管和相关肿瘤患者的治疗。
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.