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Consensus statements for management of Barrett's dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process.

ABSTRACT: BACKGROUND & AIMS:Esophageal adenocarcinoma (EA) is increasingly common among patients with Barrett's esophagus (BE). We aimed to provide consensus recommendations based on the medical literature that clinicians could use to manage patients with BE and low-grade dysplasia, high-grade dysplasia (HGD), or early-stage EA. METHODS:We performed an international, multidisciplinary, systematic, evidence-based review of different management strategies for patients with BE and dysplasia or early-stage EA. We used a Delphi process to develop consensus statements. The results of literature searches were screened using a unique, interactive, Web-based data-sifting platform; we used 11,904 papers to inform the choice of statements selected. An a priori threshold of 80% agreement was used to establish consensus for each statement. RESULTS:Eighty-one of the 91 statements achieved consensus despite generally low quality of evidence, including 8 clinical statements: (1) specimens from endoscopic resection are better than biopsies for staging lesions, (2) it is important to carefully map the size of the dysplastic areas, (3) patients that receive ablative or surgical therapy require endoscopic follow-up, (4) high-resolution endoscopy is necessary for accurate diagnosis, (5) endoscopic therapy for HGD is preferred to surveillance, (6) endoscopic therapy for HGD is preferred to surgery, (7) the combination of endoscopic resection and radiofrequency ablation is the most effective therapy, and (8) after endoscopic removal of lesions from patients with HGD, all areas of BE should be ablated. CONCLUSIONS:We developed a data-sifting platform and used the Delphi process to create evidence-based consensus statements for the management of patients with BE and early-stage EA. This approach identified important clinical features of the diseases and areas for future studies.

SUBMITTER: Bennett C

PROVIDER: S-EPMC5538857 | biostudies-literature | 2012 Aug

REPOSITORIES: biostudies-literature

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Consensus statements for management of Barrett's dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process.

Bennett Cathy C Vakil Nimish N Bergman Jacques J Harrison Rebecca R Odze Robert R Vieth Michael M Sanders Scott S Gay Laura L Pech Oliver O Longcroft-Wheaton Gaius G Romero Yvonne Y Inadomi John J Tack Jan J Corley Douglas A DA Manner Hendrik H Green Susi S Al Dulaimi David D Ali Haythem H Allum Bill B Anderson Mark M Curtis Howard H Falk Gary G Fennerty M Brian MB Fullarton Grant G Krishnadath Kausilia K Meltzer Stephen J SJ Armstrong David D Ganz Robert R Cengia Gianpaolo G Going James J JJ Goldblum John J Gordon Charles C Grabsch Heike H Haigh Chris C Hongo Michio M Johnston David D Forbes-Young Ricky R Kay Elaine E Kaye Philip P Lerut Toni T Lovat Laurence B LB Lundell Lars L Mairs Philip P Shimoda Tadakuza T Spechler Stuart S Sontag Stephen S Malfertheiner Peter P Murray Iain I Nanji Manoj M Poller David D Ragunath Krish K Regula Jaroslaw J Cestari Renzo R Shepherd Neil N Singh Rajvinder R Stein Hubert J HJ Talley Nicholas J NJ Galmiche Jean-Paul JP Tham Tony C K TC Watson Peter P Yerian Lisa L Rugge Massimo M Rice Thomas W TW Hart John J Gittens Stuart S Hewin David D Hochberger Juergen J Kahrilas Peter P Preston Sean S Sampliner Richard R Sharma Prateek P Stuart Robert R Wang Kenneth K Waxman Irving I Abley Chris C Loft Duncan D Penman Ian I Shaheen Nicholas J NJ Chak Amitabh A Davies Gareth G Dunn Lorna L Falck-Ytter Yngve Y Decaestecker John J Bhandari Pradeep P Ell Christian C Griffin S Michael SM Attwood Stephen S Barr Hugh H Allen John J Ferguson Mark K MK Moayyedi Paul P Jankowski Janusz A Z JA

Gastroenterology 20120424 2

<h4>Background & aims</h4>Esophageal adenocarcinoma (EA) is increasingly common among patients with Barrett's esophagus (BE). We aimed to provide consensus recommendations based on the medical literature that clinicians could use to manage patients with BE and low-grade dysplasia, high-grade dysplasia (HGD), or early-stage EA.<h4>Methods</h4>We performed an international, multidisciplinary, systematic, evidence-based review of different management strategies for patients with BE and dysplasia or ...[more]

PMID: 22537613

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Project description:BackgroundCoronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare system globally. Lack of high-quality evidence on the respiratory management of COVID-19-related acute respiratory failure (C-ARF) has resulted in wide variation in clinical practice.MethodsUsing a Delphi process, an international panel of 39 experts developed clinical practice statements on the respiratory management of C-ARF in areas where evidence is absent or limited. Agreement was defined as achieved when > 70% experts voted for a given option on the Likert scale statement or > 80% voted for a particular option in multiple-choice questions. Stability was assessed between the two concluding rounds for each statement, using the non-parametric Chi-square (χ2) test (p < 0·05 was considered as unstable).ResultsAgreement was achieved for 27 (73%) management strategies which were then used to develop expert clinical practice statements. Experts agreed that COVID-19-related acute respiratory distress syndrome (ARDS) is clinically similar to other forms of ARDS. The Delphi process yielded strong suggestions for use of systemic corticosteroids for critical COVID-19; awake self-proning to improve oxygenation and high flow nasal oxygen to potentially reduce tracheal intubation; non-invasive ventilation for patients with mixed hypoxemic-hypercapnic respiratory failure; tracheal intubation for poor mentation, hemodynamic instability or severe hypoxemia; closed suction systems; lung protective ventilation; prone ventilation (for 16-24 h per day) to improve oxygenation; neuromuscular blocking agents for patient-ventilator dyssynchrony; avoiding delay in extubation for the risk of reintubation; and similar timing of tracheostomy as in non-COVID-19 patients. There was no agreement on positive end expiratory pressure titration or the choice of personal protective equipment.ConclusionUsing a Delphi method, an agreement among experts was reached for 27 statements from which 20 expert clinical practice statements were derived on the respiratory management of C-ARF, addressing important decisions for patient management in areas where evidence is either absent or limited.Trial registrationThe study was registered with Clinical trials.gov Identifier: NCT04534569.

Dataset Information

Consensus statements for management of Barrett's dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process.

Publications

Consensus statements for management of Barrett's dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process.

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