Barrett’s esophagus (BE) is the precursor to esophageal adenocarcinoma (EAC). Endoscopic eradication therapy (EET) can be effective in eradicating BE and related neoplasia and has greater risk of harms and resource use than surveillance endoscopy. This clinical practice guideline aims to inform clinicians and patients by providing evidence-based practice recommendations for the use of EET in BE and related neoplasia. The Grading of Recommendations Assessment, Development and Evaluation framework was used to assess evidence and make recommendations. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients, conducted an evidence review, and used the Evidence-to-Decision Framework to develop recommendations regarding the use of EET in patients with BE under the following scenarios: presence of (1) high-grade dysplasia, (2) low-grade dysplasia, (3) no dysplasia, and (4) choice of stepwise endoscopic mucosal resection (EMR) or focal EMR plus ablation, and (5) endoscopic submucosal dissection vs EMR. Clinical recommendations were based on the balance between desirable and undesirable effects, patient values, costs, and health equity considerations. The panel agreed on 5 recommendations for the use of EET in BE and related neoplasia. Based on the available evidence, the panel made a strong recommendation in favor of EET in patients with BE high-grade dysplasia and conditional recommendation against EET in BE without dysplasia. The panel made a conditional recommendation in favor of EET in BE low-grade dysplasia; patients with BE low-grade dysplasia who place a higher value on the potential harms and lower value on the benefits (which are uncertain) regarding reduction of esophageal cancer mortality could reasonably select surveillance endoscopy. In patients with visible lesions, a conditional recommendation was made in favor of focal EMR plus ablation over stepwise EMR. In patients with visible neoplastic lesions undergoing resection, the use of either endoscopic mucosal resection or endoscopic submucosal dissection was suggested based on lesion characteristics. This document provides a comprehensive outline of the indications for EET in the management of BE and related neoplasia. Guidance is also provided regarding the considerations surrounding implementation of EET. Providers should engage in shared decision making based on patient preferences. Limitations and gaps in the evidence are highlighted to guide future research opportunities.

中文翻译：

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AGA 巴雷特食管及相关肿瘤内镜根除治疗临床实践指南


巴雷特食管 (BE) 是食管腺癌 (EAC) 的先兆。内窥镜根除治疗 (EET) 可有效根除 BE 和相关肿瘤，但与监测内窥镜检查相比，其危害和资源使用风险更大。本临床实践指南旨在通过提供关于 EET 在 BE 和相关肿瘤中使用的循证实践建议，为临床医生和患者提供信息。建议评估、制定和评价分级框架用于评估证据并提出建议。该小组根据临床问题和结果对临床医生和患者的重要性对其进行优先排序，进行证据审查，并使用证据到决策框架制定有关在以下情况下在 BE 患者中使用 EET 的建议：存在（ 1）高度不典型增生，（2）低度不典型增生，（3）无不典型增生，（4）选择逐步内镜粘膜切除术（EMR）或局部EMR加消融，以及（5）内镜粘膜下剥离术与EMR。临床建议是基于理想效果和不良效果、患者价值、成本和健康公平考虑之间的平衡。专家组就使用 EET 治疗 BE 和相关肿瘤达成了 5 项建议。根据现有证据，专家组强烈建议对 BE 高度不典型增生患者进行 EET，并有条件建议对无不典型增生的 BE 患者进行 EET。 专家组提出了有条件的建议，支持 EET 治疗 BE 低度不典型增生；对于降低食管癌死亡率的潜在危害评价较高而对获益（不确定）评价较低的 BE 低度不典型增生患者可以合理选择监测内窥镜检查。对于有明显病变的患者，有条件地建议采用局部 EMR 加消融，而不是逐步 EMR。对于需要切除的可见肿瘤病变的患者，根据病变特征建议使用内镜粘膜切除术或内镜粘膜下剥离术。本文件全面概述了 EET 在 BE 和相关肿瘤治疗中的适应症。还提供了有关实施 EET 的考虑因素的指导。提供者应根据患者的偏好参与共同决策。强调了证据的局限性和差距，以指导未来的研究机会。