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Summary for secondary care

Barrett's Oesophagus and Stage 1 Oesophageal Adenocarcinoma: Monitoring and Management

Overview

This specialist Guidelines summary covers monitoring, treatment, and follow-up for people aged 18 and over with Barrett’s oesophagus and stage 1 oesophageal adenocarcinoma. It includes advice on endoscopic and non-endoscopic techniques. It aims to improve outcomes by ensuring the most effective investigations and treatments are used.

This summary is intended for secondary care oncology teams. For further information, please refer to the full guideline.

Reflect on your learning and download our Reflection Record.

Information and Support 

Pharmacological Interventions 

Symptom Control 

Preventing Disease Progression 

  • Do not offer aspirin to people with Barrett's oesophagus to prevent progression to oesophageal dysplasia and cancer. 

Endoscopic Surveillance 

  • Discuss the benefits and risks of endoscopic surveillance with the person diagnosed with Barrett's oesophagus
  • Offer high resolution white light endoscopy with Seattle biopsy protocol for surveillance of Barrett's oesophagus. Take into account the health of the person and ensure the benefits of surveillance outweigh the risks. 

Frequency of Endoscopic Surveillance 

  • Offer high resolution white light endoscopic surveillance with Seattle protocol biopsies: 
    • every 2 to 3 years to people with long-segment (3 cm or longer) Barrett's oesophagus 
    • every 3 to 5 years to people with short-segment (less than 3 cm) Barrett's oesophagus with intestinal metaplasia
  • Assess a person's risk of cancer based on their age, sex, family history of oesophageal cancer, and smoking history, and tailor the frequency of endoscopic surveillance accordingly, within the intervals given in the previous recommendation
  • Do not offer endoscopic surveillance to people with short-segment (less than 3 cm) Barrett's oesophagus without intestinal metaplasia, provided the diagnosis has been confirmed at two endoscopies. 

Staging for Suspected Stage 1 Oesophageal Adenocarcinoma 

  • Offer endoscopic resection for staging to people with suspected stage 1 oesophageal adenocarcinoma
  • Do not use computed tomography before endoscopic resection for staging suspected T1 oesophageal adenocarcinoma
  • Do not use endoscopic ultrasonography (EUS) before endoscopic resection for staging suspected T1a oesophageal adenocarcinoma
  • Consider EUS for nodal staging for people with suspected T1b oesophageal adenocarcinoma, based on endoscopic appearances, or diagnosed with T1b oesophageal adenocarcinoma, based on histological examination of endoscopic resection specimens. 

Managing Barrett's Oesophagus with Dysplasia 

Managing Stage 1 Oesophageal Adenocarcinoma 

  • Offer a clinical consultation to people with stage 1 oesophageal adenocarcinoma to discuss and evaluate the suitability of treatment options, including endoscopic resection or oesophagectomy
  • Offer endoscopic resection as first-line treatment to people with T1a oesophageal adenocarcinoma
  • Offer endoscopic ablation of any residual Barrett's oesophagus to people with T1a oesophageal adenocarcinoma after treatment with endoscopic resection
  • Offer endoscopic follow-up to people who have received endoscopic treatment for stage 1 oesophageal adenocarcinoma
  • Offer oesophagectomy to people with T1b oesophageal adenocarcinoma who are fit for surgery and at high risk of cancer progression. For example, where there is: 
    • incomplete endoscopic resection 
    • evidence of lymphovascular invasion or deep submucosal invasion (more than 500 micron) on histological examination of endoscopic resection specimens. 

Non-surgical Treatment for T1b Oesophageal Adenocarcinoma 

  • Consider radiotherapy (alone or in combination with chemotherapy) for people with T1b oesophageal adenocarcinoma at high risk of cancer progression (for example, incomplete endoscopic resection, or evidence of lymphovascular invasion or deep submucosal invasion [more than 500 micron] on histological examination of endoscopic resection specimens) and who are unfit for oesophagectomy
  • Offer endoscopic follow-up to people who have received radiotherapy for T1b oesophageal adenocarcinoma. 

Anti-reflux Surgery 


References


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