The Chinese consensus for screening, diagnosis and management of Barrett's esophagus and early adenocarcinoma(2017, Wanning)

Abstract

Patients with Barrett's esophagus (BE)/columnar lined esophagus (CLE) and adenocarcinoma are increasing, in whom 0.61% BE/CLE would develop to adenocarcinoma. The prognosis of esophageal cancer is related to the tumor stage at diagnosis. To standardize the screening, diagnosis and therapy of BE and adenocarcinoma in China, 31 digestive diseases and digestive endoscopy experts and digestive histologists drafted the consensus on the basis of clinical experience and references. The consensus defined BE as a complication of gastroesophageal reflux disease. The normal distal squamous epithelial lining is replaced by columnar epithelial. The squamous-columnar junction (SCJ) is above the gastroesophageal junction (GEJ) ≥1 cm and proved by endoscopy and histology. Adenocarcinoma developing in BE mucosa is called BE adenocarcinoma. The early BE adenocarcinoma is divided into 4 stages: M1, M2, M3 and M4, according to the depth of tumor infiltration without expanding beyond mucosa. Because 90% esophageal cancers are esophageal squamous cell carcinoma (ESCC) in China, this consensus emphasizes the significance of screening BE and adenocarcinoma in esophageal cancers. The diagnosis of BE should meet the following criteria: under endoscopy, the normal distal squamous epithelial lining is replaced by columnar epithelial (SCJ is above the GEJ ≥1cm), which is confirmed by histology. The lesion should be further assessed by electron staining endoscopy such as narrow band imaging (NBI), flexile spectral imaging color enhancement (FICE), i-scan, and endoscopic ultrasonography (EUS) to choose the optimal therapy. Endoscopic resection such as endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) is preferred. Radiofrequency ablation (RFA), photodynamic therapy (PDT), cryotherapy, Argon plasma coagulation (APC) are alternative therapeutic regimens yet should be administrated cautiously. The standardized histologic result is very important, which can be used to assess the response effect, further treatment and follow-up schedule. It is recommended that the follow-up would better be done with high resolution endoscope. Patients without intestinal metaplasia in the four quadrants of BE and the length <3 cm is recommended to be excluded from the follow-up. BE with intestinal metaplasia<3 cm is recommended only follow-up for 3-5 years. BE and metaplasia≥3 cm is recommended to be observed every 2-3 years.