New Consensus on the Management of Barrett's Dysplasia and Early Stage Esophageal Adenocarcinoma: Limited Evidence, but Best Available Guidance (Gastroenterology 2012;143:336-346).

Barrett's esophagus (BE) is important as a precursor lesion of esophageal adenocarcinoma (EA), which has recently been rapidly increasing in incidence in the Western world. The absolute risk in individual patients with reflux esophagitis is less than 1 in 1000 per annum.1 In the United States, the annual incidence of EA in Caucasian men is 3.6/100,000 compared to 0.8 in African American men and 0.3 in Caucasian women.2 The incidence of EA will be expected to increase as the incidence of gastroesophageal reflux disease increases in the Republic of Korea. The guideline for diagnosis, surveillance, and therapy of BE was published by the American College of Gastroenterology in 1998 and updated in 2008.3 The guideline from the United Kingdom has also been updated on the Web.1 Notably, consensus on management of Barrett's dysplasia and early-stage EA has recently been reached,4 and it is thus introduced here. These guidelines were developed by international, multidisciplinary experts through systematic and evidence-based reviews of different strategies for treating patients with BE and dysplasia or early stage EA. Consensus statements were developed by the Delphi process. Until consensus for each statement reached above 80% agreement, there were total of 4 rounds of repeated anonymous voting. As a result, 81 of the 91 statements achieved consensus, including the following 8 clinical statements: (1) specimens from endoscopic resection (ER) 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 high grade dysplasia (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.