Clinical Quiz: AGA Recommendations on Endoscopic Eradication Therapy of Barrett’s Esophagus

The American Gastroenterological Association (AGA) has released new guidance on management of Barrett’s esophagus, which include 5 recommendations aimed at reducing risk of dysplasia and subsequent esophageal cancer. Published on May 17, 2024, the evidence-based guidelines were composed by a 14-person team of leading experts and clock in at 36 pages in length, with 170 reference documents.

“While the benefit is clear for patients with high-grade dysplasia, we suggest considering endoscopic eradication therapy for patients with low-grade dysplasia after clearly discussing the risks and benefits of endoscopic therapy,” said guideline author Tarek Sawas, MD, an assistant professor of Internal Medicine at UT Southwestern. “A patient-centered approach ensures that treatment decision is made collaboratively, taking into account both the medical evidence and the patient’s preferences and values. Surveillance is a reasonable option for patients who place a higher value on harms and a lower value on the uncertain benefits regarding reduction of esophageal cancer mortality.”

The 5 recommendations included in the guideline are as follows:

• Recommendation 1: In individuals with BE with HGD, the AGA recommends EET over surveillance. (Strong recommendation, moderate certainty of evidence)
• Recommendation 2: In individuals with BE with LGD, the AGA suggests for EET over surveillance. Patients who place a higher value on the well-defined harms and lower value on the benefits (which are uncertain) regarding reduction of esophageal cancer mortality would reasonably select surveillance endoscopy. (Conditional recommendation, low certainty of evidence)
• Recommendation 3: In individuals with NDBE, the AGA suggests against the routine use of EET. (Conditional recommendation, very low certainty of evidence)
• Recommendation 4: In patients undergoing EET, the AGA suggests resection of visible lesions followed by ablation of the remaining BE segment over resection of the entire BE segment. (Conditional recommendation, very low certainty of evidence)
• Recommendation 5: In individuals with BE with visible neoplastic lesions that are undergoing endoscopic resection, the AGA suggests the use of either EMR or ESD based on lesion characteristics. (Conditional recommendation, very low certainty of evidence)

To recognize the creation of these guidelines and the recommendations included in them, HCPLive Gastroenterology has developed a clinical quiz based on the guidelines, which can be found below.

The incidence of EAC rose by how much from the 1970s to the 2010s?

Reference:

Rubenstein JH, Sawas T, Wani S, et al. AGA Clinical Practice Guideline on Endoscopic Eradication Therapy of Barrett's Esophagus and Related Neoplasia. Gastroenterology. 2024;166(6):1020-1055. doi:10.1053/j.gastro.2024.03.019.

Editor's note: this quiz was composed with the assistance of artificial intelligence tools.