Practice Guidance

Esophageal and Gastric Disorders

Clinical Practice Updates (CPUs) are intended to inform clinicians, payors and other interested parties of AGA’s concerning areas of clinical practice and/or technologies that are widely available or new to the practice of gastroenterology. CPUs present the current state-of-the-art and by definition will include a combination of strong, evidence-based information, and when not available, best consensus opinion.

Harry R. Aslanian, Jeffrey H. Lee and Marcia Irene Canto describe the indications for screening for pancreas cancer in high-risk individuals.

Ronnie Fass, Frank Zerbib, and C. Prakash Gyawali provide seven pieces of best practice advice for the clinical presentation, modern diagnosis and management of functional heartburn.

Prateek Sharma, Nicholas J. Shaheen, David Katzka and Jacques J.G.H.M. Bergman describe the role of Barrett’s endoscopic therapy in patients with Barrett’s esophagus with dysplasia and/or early cancer and appropriate follow-up of these patients.

Todd H. Baron, MD, FASGE, Christopher J. DiMaio, MD, AGAF, Andrew Y. Wang, MD, AGAF, Katherine A. Morgan, MD, discuss the best practice advice and the most available evidence regarding the clinical care of patients with pancreatic necrosis for optimal patient management. Pancreatic necrosis is associated with substantial morbidity and mortality. Optimal management requires a multidisciplinary approach including gastroenterologists, surgeons, interventional radiologists and specialists in critical care medicine, infectious disease and nutrition.

Mohamed O. Othman, MD, Jeffrey H. Lee, MD, MPH, FACG, FASGE, AGAF, Kenneth Wang, MD, AGAF discuss whether to recommend endoscopic submucosal dissection (ESD) over surgical resection, if ESD provides treatment as effective as surgical resection for patients with early stage esophageal adenocarcinomas (T1a and T1b). ESD has been gaining momentum as an alternative to surgery in treating early gastrointestinal neoplasms. It is a less invasive treatment and patients benefit from a shorter hospital stay without diminished quality of life from new or increased reflux symptoms.

Peter V. Dragonov, MD, FASGE, AGAF, Andrew Y. Wang, MD, AGAF, Mohamed O. Othman, MD, Norio Fukami, MD, AGAF provide a review of endoscopic submucosal dissection (ESD), an established endoscopic resection method in Asian countries, which is gaining practice in Europe and by early adopters in the U.S. for the removal of early cancer and large lesions from the luminal gastrointestinal tract. They discuss the importance of physicians making themselves aware of latest updates in ESD, specifically in the United States, as it becomes more utilized.

Michael F. Vaezi, MD, PhD, MSc, David Katzka, MD, and Frank Zerbib outline the recent developments in the field of extraesophageal reflux disease and provide clinically relevant recommendations. The recommendations outlined in this review are based on expert opinion and on relevant publications from PubMed and EMbase.

Stuart J. Spechler, MD, AGAF, David A. Katzka, MD, and Rebecca C. Fitzgerald, MD, AGAF review the different approaches investigators have explored to obviate the limitations of current screening practices imposed by the requirement for chronic gastroesophageal reflux disease (GERD) symptoms and the high cost of endoscopy. They discuss whether they are ready for practice application, and, if not, what are the barriers that need to be overcome before we can recommend their clinical use.

Reviews progress in our awareness and understanding of infections using ERCP endoscopes, as well as currently proposed solutions.

Evaluation of the risks associated with long-term use of proton pump inhibitors (PPIs) for GERD, Barrett’s esophagus and NSAID bleeding prophylaxis.

Describes the technique and reviews potential indications in achalasia, eosinophilic esophagitis and GERD.

Update and practice advice on how to incorporate endoscopic bariatric therapies into clinical practice.

Reviews the role of per-oral endoscopic myotomy (POEM) among the currently available treatments for achalasia.

Expert review defining key principles in the diagnosis and management of low-grade dysplasia in Barrett’s esophagus.

Discussion of the major changes to the 2016 guideline update and the implications on practice.

Patient Companions

After finding Barrett’s esophagus, your doctor will do a biopsy (taking a small piece of tissue to look at under a microscope) to check how bad the disease is.