National Institute for Health and Care Excellence (NICE) guidance on monitoring and management of Barrett's oesophagus and stage I oesophageal adenocarcinoma.

Autor:	di Pietro M; Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, UK md460@cam.ac.uk., Trudgill NJ; Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK.; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK., Vasileiou M; National Institute for Health and Care Excellence, London, UK., Longcroft-Wheaton G; Department of Gastroenterology, Portsmouth Hospitals NHS Trust, Portsmouth, UK.; Department of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK., Phillips AW; Department of Surgery, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK., Gossage J; Department of Gastrointestinal Surgery, St Thomas' Hospital, London, UK., Kaye PV; Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK., Foley KG; Division of Cancer and Genetics, Cardiff University, Cardiff, Cardiff, UK., Crosby T; Department of Clinical Oncology, Velindre University NHS Trust, Cardiff, UK., Nelson S; Kenmore Medical Centre, Manchester University NHS Foundation Trust, Manchester, UK., Griffiths H; Powys Teaching Health Board, Bronllys, UK., Rahman M; National Institute for Health and Care Excellence, London, UK., Ritchie G; National Institute for Health and Care Excellence, London, UK., Crisp A; National Institute for Health and Care Excellence, London, UK., Deed S; National Institute for Health and Care Excellence, London, UK., Primrose JN; Department of Surgery, University of Southampton, Southampton, UK.
Jazyk:	angličtina
Zdroj:	Gut [Gut] 2024 May 10; Vol. 73 (6), pp. 897-909. Date of Electronic Publication: 2024 May 10.
DOI:	10.1136/gutjnl-2023-331557
Abstrakt:	Barrett's oesophagus is the only known precursor to oesophageal adenocarcinoma, a cancer with very poor prognosis. The main risk factors for Barrett's oesophagus are a history of gastro-oesophageal acid reflux symptoms and obesity. Men, smokers and those with a family history are also at increased risk. Progression from Barrett's oesophagus to cancer occurs via an intermediate stage, known as dysplasia. However, dysplasia and early cancer usually develop without any clinical signs, often in individuals whose symptoms are well controlled by acid suppressant medications; therefore, endoscopic surveillance is recommended to allow for early diagnosis and timely clinical intervention. Individuals with Barrett's oesophagus need to be fully informed about the implications of this diagnosis and the benefits and risks of monitoring strategies. Pharmacological treatments are recommended for control of symptoms, but not for chemoprevention. Dysplasia and stage 1 oesophageal adenocarcinoma have excellent prognoses, since they can be cured with endoscopic or surgical therapies. Endoscopic resection is the most accurate staging technique for early Barrett's-related oesophageal adenocarcinoma. Endoscopic ablation is effective and indicated to eradicate Barrett's oesophagus in patients with dysplasia. Future research should focus on improved accuracy for dysplasia detection via new technologies and providing more robust evidence to support pathways for follow-up and treatment. Competing Interests: Competing interests: MdP participated in the BEST3 screening trial and received consultant fees from Medtronic. JNP was chair of the trial Steering committee of the AspECT trial. NJT participated in the AspECT trial. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)
Databáze:	MEDLINE
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