BOB CAT: A large-scale review and delphi consensus for management of Barrett's esophagus with no dysplasia, indefinite for, or low-grade dysplasia

Bennett C, Moayyedi P, Corley DA, Decaestecker J, Falck-Ytter Y, Falk G, Vakil N, Sanders S, Vieth M, Inadomi J, Aldulaimi D, Ho KY, Odze R, Meltzer SJ, Quigley E, Gittens S, Watson P, Zaninotto G, Iyer PG, Alexandre L, Ang Y, Callaghan J, Harrison R, Singh R, Bhandari P, Bisschops R, Geramizadeh B, Kaye P, Krishnadath S, Fennerty MB, Manner H, Nason KS, Pech O, Konda V, Ragunath K, Rahman I, Romero Y, Sampliner R, Siersema PD, Tack J, Tham TC, Trudgill N, Weinberg DS, Wang J, Wang K, Wong JY, Attwood S, Malfertheiner P, MacDonald D, Barr H, Ferguson MK, Jankowski J (2015)

Publication Type: Journal article, Review article

Publication year: 2015

Journal

Book Volume: 110

Pages Range: 662-682

Journal Issue: 5

DOI: 10.1038/ajg.2015.55

Abstract

OBJECTIVES:Barrett's esophagus (BE) is a common premalignant lesion for which surveillance is recommended. This strategy is limited by considerable variations in clinical practice. We conducted an international, multidisciplinary, systematic search and evidence-based review of BE and provided consensus recommendations for clinical use in patients with nondysplastic, indefinite, and low-grade dysplasia (LGD).METHODS:We defined the scope, proposed statements, and searched electronic databases, yielding 20,558 publications that were screened, selected online, and formed the evidence base. We used a Delphi consensus process, with an 80% agreement threshold, using GRADE (Grading of Recommendations Assessment, Development and Evaluation) to categorize the quality of evidence and strength of recommendations.RESULTS:In total, 80% of respondents agreed with 55 of 127 statements in the final voting rounds. Population endoscopic screening is not recommended and screening should target only very high-risk cases of males aged over 60 years with chronic uncontrolled reflux. A new international definition of BE was agreed upon. For any degree of dysplasia, at least two specialist gastrointestinal (GI) pathologists are required. Risk factors for cancer include male gender, length of BE, and central obesity. Endoscopic resection should be used for visible, nodular areas. Surveillance is not recommended for <5 years of life expectancy. Management strategies for indefinite dysplasia (IND) and LGD were identified, including a de-escalation strategy for lower-risk patients and escalation to intervention with follow-up for higher-risk patients.CONCLUSIONS:In this uniquely large consensus process in gastroenterology, we made key clinical recommendations for the escalation/de-escalation of BE in clinical practice. We made strong recommendations for the prioritization of future research.

Authors with CRIS profile

Involved external institutions

Brigham and Women's Hospital (BWH) United States (USA) (US) Johns Hopkins Hospital United States (USA) (US) Houston Methodist United States (USA) (US) Queen's University United Kingdom (GB) Mayo Clinic United States (USA) (US) University of East Anglia United Kingdom (GB) University of Manchester United Kingdom (GB) University Hospital Southampton NHS United Kingdom (GB) Oregon Health and Science University (OSHU) United States (USA) (US) Katholieke Universiteit Leuven (KUL) / Catholic University of Leuven Belgium (BE) Durham University United Kingdom (GB) University of Chicago United States (USA) (US) Coventry University United Kingdom (GB) McMaster University Canada (CA) Kaiser Permanente United States (USA) (US) Leicester General Hospital United Kingdom (GB) Case Western Reserve University United States (USA) (US) University of Pennsylvania (UPenn) United States (USA) (US) University of Wisconsin - Madison United States (USA) (US) University of Warwick United Kingdom (GB) Klinikum Bayreuth Germany (DE) University of Arizona United States (USA) (US) University of Washington United States (USA) (US) Worcestershire Acute Hospitals NHS Trust United Kingdom (GB) National University of Singapore (NUS) Singapore (SG) University of Adelaide Australia (AU) Queen Alexandra Hospital United Kingdom (GB) University Hospital Leuven (UZ) / Universitaire ziekenhuizen Leuven Belgium (BE) Shiraz University of Medical Sciences / دانشگاه علوم پزشکی شیراز Iran, Islamic Republic of (IR) Nottingham University Hospitals United Kingdom (GB) Amsterdam University Medical Centers (Amsterdam UMC) / Amsterdam Universitair Medische Centra Netherlands (NL) University of Pittsburgh United States (USA) (US) University of Nottingham United Kingdom (GB) University Medical Centre Utrecht (UMC Utrecht) Netherlands (NL) University of Ulster United Kingdom (GB) Sandwell and West Birmingham NHS Hospital United Kingdom (GB) Fox Chase Cancer Center United States (USA) (US) Washington University in St. Louis United States (USA) (US) NUS Yong Loo Lin School of Medicine Singapore (SG) Otto-von-Guericke-Universität Magdeburg Germany (DE) University of British Columbia Canada (CA) Gloucestershire Hospitals United Kingdom (GB) Krankenhaus Barmherzige Brüder Germany (DE) University Hospitals Coventry and Warwickshire United Kingdom (GB)

How to cite

APA:

Bennett, C., Moayyedi, P., Corley, D.A., Decaestecker, J., Falck-Ytter, Y., Falk, G.,... Jankowski, J. (2015). BOB CAT: A large-scale review and delphi consensus for management of Barrett's esophagus with no dysplasia, indefinite for, or low-grade dysplasia. American Journal of Gastroenterology, 110(5), 662-682. https://doi.org/10.1038/ajg.2015.55

MLA:

Bennett, Cathy, et al. "BOB CAT: A large-scale review and delphi consensus for management of Barrett's esophagus with no dysplasia, indefinite for, or low-grade dysplasia." American Journal of Gastroenterology 110.5 (2015): 662-682.

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