This is the current release of the guideline.

• Gastroesophageal reflux disease (GERD)
• Complications of GERD such as Barrett's esophagus (BE)

Diagnosis
Evaluation
Management
Treatment

Family Practice
Gastroenterology
Internal Medicine

Physicians

To discuss the use of endoscopy for the diagnosis and management of gastroesophageal reflux disease (GERD) and Barrett's esophagus (BE)

Patients with gastroesophageal reflux disease (GERD) and Barrett's esophagus (BE)

1. Esophagogastroduodenoscopy (EGD)
2. Biopsy
3. Classification of gastroesophageal reflux disease (GERD) according to an accepted grading scale (the Los Angeles classification or the Savary-Miller classification) or detailed description of endoscopic findings
4. Endoscopic antireflux therapy for selected patients

• Accuracy and specificity of diagnostic tests
• Incidence and economic impact of gastroesophageal reflux disease (GERD)
• Cost-effectiveness of endoscopic evaluation, screening and/or treatment
• Safety of endoscopic procedures

Hand-searches of Published Literature (Primary Sources)
Searches of Electronic Databases

In preparing this guideline, a search of the medical literature was performed using PubMed, supplemented by accessing the "related articles" feature of PubMed. Additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When little or no data exist from well-designed prospective trials, emphasis is given to results from large series and reports from recognized experts.

Not stated

Expert Consensus (Committee)

Not applicable

Systematic Review

Not stated

Expert Consensus

Guidelines for appropriate utilization of endoscopy are based on a critical review of the available data and expert consensus.

Grades of Recommendation*

*Adapted from Guyatt G, Sinclair J, Cook D, Jaeschke R, Schunemann H, Pauker S. Moving from evidence to action: grading recommendations—a qualitative approach. In: Guyatt G, Rennie D, eds. Users' guides to the medical literature. Chicago: AMA Press; 2002. p. 599-608.

Published cost analyses were reviewed.

A landmark modeling study showed that a strategy of endoscopic screening for Barrett's esophagus (BE) in 50-year-old white males with gastroesophageal reflux disease (GERD) followed by subsequent endoscopic surveillance for those with dysplasia was associated with acceptable costs per quality-adjusted life year saved. Several other modeling studies reached similar conclusions regarding screening for this specific population but differed regarding the cost effectiveness of additional surveillance in patients with nondysplastic BE.

Internal Peer Review

This document was reviewed and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy.

Recommendations were graded on the strength of the supporting evidence (Grades 1A-3). Definitions of the recommendation grades are presented at the end of the "Major Recommendations" field.

Summary

• Gastroesophageal reflux disease (GERD) can be diagnosed on the basis of typical symptoms without the need for diagnostic testing, including endoscopy (1C).
• In patients with uncomplicated GERD, an initial trial of empiric medical therapy is appropriate (1C).
• Endoscopy is recommended for patients who have symptoms suggesting complicated GERD or alarm symptoms (2A).
• Endoscopic findings of reflux esophagitis should be classified according to an accepted grading scale or described in detail (3).
• Endoscopy should be considered in patients at risk for Barrett's esophagus (BE) (2C).
• Biopsy must be performed to confirm endoscopically suspected BE (2B).
• Endoscopic biopsy specimens should not be obtained from an endoscopically normal tissue to exclude BE (2B).
• For patients with established BE of any length and with no dysplasia, after 2 consecutive examinations within 1 year, an acceptable interval for additional surveillance is every 3 years (3).
• Endoscopic antireflux therapy may be considered for selected patients with uncomplicated GERD after careful discussion with the patient regarding potential side effects, benefits, and other available therapeutic options (3).

Definitions:

Grades of Recommendation*

*Adapted from Guyatt G, Sinclair J, Cook D, Jaeschke R, Schunemann H, Pauker S. Moving from evidence to action: grading recommendations—a qualitative approach. In: Guyatt G, Rennie D, eds. Users' guides to the medical literature. Chicago: AMA Press; 2002. p. 599-608.

None provided

The type of supporting evidence is identified for each recommendation (see "Major Recommendations").

Appropriate utilization of endoscopy in the diagnosis and management of patients with gastroesophageal reflux disease (GERD) and Barrett's esophagus (BE)

• Drawbacks of esophagogastroduodenoscopy (EGD) include the potential physical risks, financial costs, and limited access to the procedure.
• Short- and long-term safety issues surrounding the endoluminal devices continue to be a concern, and the economics of their use are unknown.

• Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data appear. Clinical consideration may justify a course of action at variance to these recommendations.
• This guideline is intended to be an educational device to provide information that may assist endoscopists in providing care to patients. This guideline is not a rule and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment. Clinical decisions in any particular case involve complex analysis of the patient's condition and available courses of action. Therefore, clinical considerations may lead an endoscopist to take a course of action that varies from these guidelines.

An implementation strategy was not provided.

Getting Better
Living with Illness

Effectiveness

Not applicable: The guideline was not adapted from another source.

2007 Aug

American Society for Gastrointestinal Endoscopy - Medical Specialty Society

American Society for Gastrointestinal Endoscopy

Standards of Practice Committee

Committee Members: David R. Lichtenstein, MD; Brooks D. Cash, MD; Raquel Davila, MD; Todd H. Baron, MD, Chair; Douglas G. Adler, MD; Michelle A. Anderson, MD; Jason A. Dominitz, MD, MHS; Seng-Ian Gan, MD; M. Edwyn Harrison III, MD; Steven O. Ikenberry, MD; Waqar A. Qureshi, MD; Elizabeth Rajan, MD; Bo Shen, MD; Marc J. Zuckerman, MD; Robert D. Fanelli, MD, SAGES Representative; Trina VanGuilder, RN, BSN, SGNA Representative

Not stated

This is the current release of the guideline.

None available

None available

This NGC summary was completed by ECRI Institute on March 3, 2008.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.