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Largest review of management and treatment of Barrett's dysplasia and adenocarcinoma
Date:7/23/2012

while they are still in their early stages. However, there is a lack of agreement on the best way of managing and treating them.

Having reviewed all the available studies, Professor Jankowski and his colleagues drafted statements on the diagnosis, epidemiology, methods of surveillance, approaches to treatment, and prevention of high-grade dysplasia and early adenocarcinoma in patients with Barrett's oesophagus. Then they conducted four rounds of anonymous voting on the statements until consensus was achieved in 81 of the 91 statements (consensus meant that 80 per cent or more strongly agreed or agreed with reservation on a statement). This is known as the Delphi process.

"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," said Professor Jankowski. "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."

Endoscopy involves the insertion of a thin tube that contains a light source, a video camera and, when necessary, instruments for performing surgery or taking tissue samples. For Barrett's oesophagus, dysplasia and oesophageal cancer, it is inserted via the throat, avoiding the need for a surgeon to open the chest to access the oesophagus.

Professor Jankowski said: "This huge systematic review using the Delphi process with 92 international experts really does underline that hospitals need good equipment, doctors need the best training in both diagnostic and endoscopic techniques and a good expert pathologist to process the samples. In times of cutbacks it is likely that some units will refer patients to larger centres nearby. Although some pat
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Contact: Emma Mason (media enquiries only)
e.mason@qmul.ac.uk
Queen Mary, University of London
Source:Eurekalert

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