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Esôfago de Barrett (metaplasia intestinal do esôfago distal com células de cáscara em b...

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IDRF-BARRETTS-ESOPHAGUS-PREVENTION
TipoSinal de alerta
Estadoreviewed 2026-05-18 | pending_clinical_signoff
DoençasDIS-ESOPHAGEAL
FontesSRC-ESMO-ESOPHAGEAL-2024 SRC-NCCN-ESOPHAGEAL-2025

Origem da bandeira vermelha

DefiniçãoBarrett's esophagus (intestinal metaplasia of the distal esophagus with goblet cells on biopsy after EGD performed for chronic GERD or Barrett's-specific surveillance) in an individual without a current esophageal adenocarcinoma diagnosis. Established precursor lesion to esophageal adenocarcinoma — annual progression rates: non-dysplastic Barrett's ~0.1-0.3%/year to EAC, low-grade dysplasia (LGD) ~0.7-2%/year, high-grade dysplasia (HGD) ~7-19%/year. Endoscopic surveillance and endoscopic eradication therapy (radiofrequency ablation, endoscopic mucosal resection) for dysplastic Barrett's substantially reduce EAC incidence and mortality. Prevention-persona RedFlag (§20 ratification 2026-05-18, v0.3 chronic-condition pilot).
Direcção clínicainvestigar
CategoriaOutros

Lógica de Desencadeamento

{
  "any_of": [
    {
      "finding": "barretts_esophagus_diagnosis_confirmed",
      "value": true
    },
    {
      "finding": "barretts_esophagus_with_dysplasia_low_grade",
      "value": true
    },
    {
      "finding": "barretts_esophagus_with_dysplasia_high_grade",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notas

v0.3 chronic-condition prevention pilot — Barrett's esophagus. Prevention-persona RedFlag (CHARTER §3 amended 2026-05-18 Path A, HCP-mediated). Fires when patient profile shows confirmed Barrett's esophagus (with or without dysplasia) AND no confirmed esophageal adenocarcinoma. Engine routes such patients to a PreventionPlan with 2 tracks: intensified EGD surveillance per ACG/NCCN cadences (IND-BARRETTS-ESOPHAGUS-PREVENTION-SURVEILLANCE) as the standard pathway; routine q5y EGD observation (IND-BARRETTS-ESOPHAGUS- PREVENTION-OBSERVATION) as the alternative — appropriate ONLY for confirmed non-dysplastic Barrett, not for any dysplasia grade. Evidence for surveillance + endoscopic eradication therapy reducing EAC incidence: HGD ablation reduces progression to EAC by ~75% vs observation (Shaheen et al. JAMA 2014; AIM-Dysplasia trial). LGD ablation reduces progression to HGD/EAC by ~75% (SURF trial, Phoa et al. JAMA 2014). For non-dysplastic Barrett, surveillance does not reduce incidence but improves earliest-stage detection. Dysplasia management: LGD → endoscopic eradication therapy (RFA ± EMR for visible lesions) OR intensified surveillance q6-12mo if patient declines. HGD → endosc...

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Indicação

Sinal de alerta