Best Practices for Esophageal Cancer Treatment

Published in the journal Gastroenterology and led by Professor Janusz Jankowski, a new study reviewed almost 12,000 papers on the care and treatment of Barrett’s Dysplasia and early-stage esophageal adenocarcinoma. The findings were analyzed using the Delphi process.

The Delphi process is a novel method of analysis that allows researchers to attain an agreement on all reviewed papers’ strengths of evidence.  The goal is to use the findings as a means of recommending ways to manage these conditions in patients. This study is the first in its attempt to review all available research in this field.

Barrett’s esophagus is a condition characterized by unusual changes within the cells that line the lower end of the esophagus, and is usually the result of acid reflux. During the last several years, the incidence rate for the condition has been rising steadily, with 10-20% of patients with acid reflux developing Barrett’s esophagus. The condition can then evolve into Barrett’s dysplasia and cells become pre-cancerous and can eventually develop into esophageal adenocarcinoma.

Considering that the adenocarcinoma diagnosis has a poor 5-year survival rate of less than 15%, early detection and treatment in its earliest phase is of the utmost importance. However, there have been disagreements between experts on the best way to manage the disease.

Professor Jankowski and his research team drafted statements on the diagnosis, epidemiology, methods of surveillance, treatment approaches and prevention of high-grade dysplasia and early adenocarcinoma among patients with Barrett’s esophagus. Using the Delphi process, they performed four rounds of anonymous voting on the statements until they reached a consensus in 81 of the 91 statements. A consensus of 80% or greater was defined as agreeing strongly agreed.

Professor Jankowski concluded, "The key messages to emerge from this process are that the endoscopic equipment needs to be good (vital in times of cutbacks) and that endoscopic surgery can be better than the more risky open surgery. In addition, there needs to be more and larger samples of tissues taken so that the pathologist can make sure that no early cancers are missed. At present, there are no reliable biomarkers (molecular changes) that can replace good equipment, a well-trained endoscopist and a methodical pathologist."

www.gastrojournal.org/