Chinese consensus: screening, diagnosis and management of Barrett's esophagus and adenocarcinoma(2017 Wanning)
Abstract：There are more and more patients with Barrett's Esophagus (BE) / Columnar lined Esophagus (CLE) and adenocarcinoma,and about 0.61％ BE/CLE will develop to adenocarcinoma.The prognosis of esophageal cancer is related to the stage of tumor when it is diagnosed.Aimed at normalizing the screening,diagnosis and therapy of Barrett's Esophagus (BE) and adenocarcinoma in China,31 professors of digestive diseases,digestive endoscopy and digestive histologists made the consensus on the basis of clinical experience and lots of references.The consensus defines the BE as a complication of gastroesophageal reflux disease (GERD),the normal distal squamous epithelial lining is replaced by columnar epithelial and this must be cleafly visible endoscopically [the squamous-columnar junction (SCJ) is above the gastroesophageal junction (GEJ) ≥ 1 cm] and be confirmed by histology.Adenocarcinoma occurring on BE mucosa is called Barrett's esophageal adenocarcinoma.The early Barrett's esophageal adenocarcinoma is the tumor that localizes in mucosa,and is divided into 4 stages:M1,M2,M3 and M4,according to the tumor infiltration depth.in our country about 90％ esophageal cancers are esophageal squamous cell carcinoma (ESCC),so the consensus recommends that the screening of BE and adenocarcinomas should be emphasized in the screening of ESCC.When diagnosing BE we should have the evidences that it is clearly visible endoscopically that the normal distal squamous epithelial lining is replaced by columnar epithelial (SCJ is above the GEJ ≥ 1 cm),and it is confirmed by histology.The lesion should be further assessedby electron staining endoscopy,such as NBI,FICE and i-scan,and endoscopic ultrasonography (EUS),to help to select the suitable therapy.Endoscopic resection such as ESD and EMR is the preferred therapy,and radiofrequancy ablation (RFA),photodynamic therapy (PDT),Cryotherapy,Argon Plasma Coagulation (APC) should be selected cautiously.The normalized histologic result is very important.We can use it to assess the effect of therapy,whether to perform further treatment and the follow-up.It is recommended that the follow-up should better be done with high resolution endoscope.If it is confirmed that there is no intestinal metaplasia or dysplasia and repeat biopsies in the four quadrants proves BE without intestinal metaplasia or dysplasia and the length ＜ 3 cm,it is recommended to be excluded from the follow-up.BE with intestinal metaplasia and the length ＜3 cm is recommended to be observed every 3-5 years.BE with the length ＞3cm is recommended to be observed every 2-3 years by endoscope.
Keywords：Barrett esophagusadenocarcinomaconsensus
Publication Date：2017-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：12( 798-809 )