DESCRIPTION The purpose of this best practice advice article is to describe the role of Barrett's endoscopic therapy (BET) in patients with Barrett's esophagus (BE) with dysplasia and/or early cancer and appropriate follow-up of these patients. METHODS The best practice advice provided in this document is based on evidence and relevant publications reviewed by the committee. BEST PRACTICE ADVICE 1: In BE patients with confirmed low-grade dysplasia, a repeat examination with high-definition white-light endoscopy should be performed within 3-6 months to rule out the presence of a visible lesion, which should prompt endoscopic resection. BEST PRACTICE ADVICE 2: Both BET and continued surveillance are reasonable options for the management of BE patients with confirmed and persistent low-grade dysplasia. BEST PRACTICE ADVICE 3: BET is the preferred treatment for BE patients with high-grade dysplasia (HGD). BEST PRACTICE ADVICE 4: BET should be preferred over esophagectomy for BE patients with intramucosal esophageal adenocarcinoma (T1a). BEST PRACTICE ADVICE 5: BET is a reasonable alternative to esophagectomy in patients with submucosal esophageal adenocarcinoma (T1b) with low-risk features (<500-μm invasion in the submucosa [sm1], good to moderate differentiation, and no lymphatic invasion) especially in those who are poor surgical candidates. BEST PRACTICE ADVICE 6: In all patients undergoing BET, mucosal ablation should be applied to 1) all visible esophageal columnar mucosa; 2) 5-10 mm proximal to the squamocolumnar junction and 3) 5-10 mm distal to the gastroesophageal junction, as demarcated by the top of the gastric folds (ie, gastric cardia) using focal ablation in a circumferential fashion. BEST PRACTICE ADVICE 7: Mucosal ablation therapy should only be performed in the presence of flat BE without signs of inflammation and in the absence of visible abnormalities. BEST PRACTICE ADVICE 8: BET should be performed by experts in high-volume centers that perform a minimum of 10 new cases annually. BEST PRACTICE ADVICE 9: BET should be continued until there is an absence of columnar epithelium in the tubular esophagus on high-definition white-light endoscopy and preferably optical chromoendoscopy. In case of complete endoscopic eradication, the neosquamous mucosa and the gastric cardia are sampled by 4-quadrant biopsies. BEST PRACTICE ADVICE 10: If random biopsies obtained from the neosquamous epithelium demonstrate intestinal metaplasia/dysplasia or subsquamous intestinal metaplasia, a repeat endoscopy should be performed and visible islands or tongues should undergo targeted focal ablation. BEST PRACTICE ADVICE 11: Intestinal metaplasia of the gastric cardia (without residual columnar epithelium in the tubular esophagus) should not warrant additional ablation therapy. BEST PRACTICE ADVICE 12: When consenting patients for BET, the most common complication of therapy to be quoted is post-procedural stricture formation, occurring in about 6% of cases. Bleeding and perforation occur at rates <1%. BEST PRACTICE ADVICE 13: After complete eradication (endoscopic and histologic) of intestinal metaplasia has been achieved with BET, surveillance endoscopy with biopsies should be performed at the following intervals: for baseline diagnosis of HGD/esophageal adenocarcinoma: at 3, 6, and 12 months and annually thereafter; and baseline diagnosis of low-grade dysplasia: at 1 and 3 years. BEST PRACTICE ADVICE 14: Endoscopic surveillance post therapy should be performed with high-definition white-light endoscopy, including careful inspection of the neosquamous mucosal and retroflexed inspection of the gastric cardia. BEST PRACTICE ADVICE 15: The approach to recurrent disease is similar to that of the initial therapy; visible recurrent nodular lesions require endoscopic resection, whereas flat areas of columnar mucosa in the tubular esophagus can be treated with mucosal ablation. BEST PRACTICE ADVICE 16: Patients should be counseled on cancer risk in the absence of BET, as well as after BET, to allow for informed decision-making between the patient and the physician.

中文翻译：

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AGA内镜治疗不典型增生和/或早期癌症的Barrett食管的临床实践更新：专家点评。

描述本最佳实践建议文章的目的是描述Barrett内镜治疗（BET）在患有异型增生和/或早期癌症的Barrett食道（BE）患者中的作用以及对这些患者的适当随访。方法本文档中提供的最佳实践建议是基于委员会审查的证据和相关出版物。最佳实践建议1：对于确诊为轻度不典型增生的BE患者，应在3到6个月内用高清白光内镜进行复查，以排除可见病变的发生，并应进行内窥镜切除术。最佳实践建议2：对于确诊并持续存在低度发育不良的BE患者，BET和持续监测都是合理的选择。最佳做法建议3：BET是患有高度不典型增生（HGD）的BE患者的首选治疗方法。最佳实践建议4：对于BE黏膜内食管腺癌（T1a）患者，应首选BET法而不是食管切除术。最佳实践建议5：对于具有低风险特征（<500μm黏膜下层[sm1]浸润，良好至中度分化且无淋巴结浸润）的粘膜下食管腺癌（T1b）患者，BET是食管切除术的合理替代方案在那些较差的外科手术候选人中。最佳实践建议6：在所有进行BET的患者中，应对1）所有可见的食管柱状粘膜进行粘膜消融；2）距胃小柱交界处近5-10 mm，以及3）距胃食管交界处5-10 mm远，如胃褶皱顶部所划定的（即，胃card门）以圆周方式使用局部消融术。最佳实践建议7：仅在存在BE且无炎症迹象且无可见异常的情况下，才应进行粘膜消融治疗。最佳实践建议8：BET应由每年至少处理10个新病例的高容量中心的专家进行。最佳实践建议9：在高清晰度白光内窥镜检查（最好是光学色内窥镜检查）下，应持续进行BET直到肾小管食管中没有柱状上皮为止。如果彻底根除内镜，则通过四象限活检对新鳞状黏膜和胃card门进行取样。最佳做法建议10：如果从新鳞状上皮获得的随机活检显示肠上皮化生/异型增生或鳞状肠下皮化生，则应进行重复内镜检查，可见的岛或舌应进行靶向性局部消融。最佳实践建议11：胃card门的肠上皮化生（管状食管中没有残留的柱状上皮）不应保证额外的消融治疗。最佳实践建议12：当同意患者进行BET治疗时，最常见的治疗并发症是手术后狭窄的形成，约有6％的病例发生。出血和穿孔的发生率<1％。最佳做法建议13：用BET彻底根除（内镜和组织学检查）肠化生后，监测内窥镜检查和活检应按以下间隔进行：对于HGD /食管腺癌的基线诊断：3、6和12个月，此后每年一次；轻度不典型增生的基线诊断：1年和3年。最佳实践建议14：治疗后的内窥镜监测应使用高清白光内窥镜进行，包括仔细检查新鳞状粘膜和后弯检查胃card门。最佳实践建议15：复发性疾病的治疗方法与最初的治疗方法相似。可见的复发性结节性病变需要内镜下切除，而管状食管中柱状粘膜的平坦区域可以用粘膜消融术治疗。最佳做法建议16：在没有BET的情况下，应就癌症风险向患者提供咨询，