Screening and Surveillance for Barrett's Esophagus
Screening and Surveillance for Barrett's Esophagus
Purpose of review Our article discusses the current understanding of screening and surveillance options for Barrett's esophagus and emerging concepts that have the potential to improve the effectiveness and cost-effectiveness of surveillance.
Recent findings Although endoscopic surveillance of patients with Barrett's esophagus is commonly practiced in order to detect high-grade dysplasia and early esophageal adenocarcinoma (EAC), the reported incidence of EAC in Barrett's esophagus patients varies widely. Recent studies found the risk of progression from Barrett's esophagus to EAC to be significantly lower than previously reported, raising concerns regarding the limitations of current surveillance strategies. Advances in imaging techniques and their enhanced diagnostic accuracy may improve the value of endoscopic surveillance. Additionally, various efforts are ongoing to identify biomarkers that identify individuals at higher risk of cancer, possibly allowing for individual risk stratification.
Summary These new data highlight some of the opportunities to revise and improve surveillance in patients with Barrett's esophagus. The incorporation of new advances such as imaging techniques and biomarkers has the potential to improve the effectiveness and cost-effectiveness of new surveillance regimens.
The incidence of esophageal adenocarcinoma (EAC) has been drastically increasing over the past 40 years, particularly in Western populations. Efforts to curb this rise in EAC incidence have focused on screening for Barrett's esophagus, a precursor to EAC. Current practice has been to selectively screen individuals over the age of 50 with a history of chronic gastroesophageal reflux disease (GERD) symptoms to identify patients with Barrett's esophagus. For the patients diagnosed with Barrett's esophagus, older guidelines recommended endoscopic surveillance in an effort to reduce morbidity and mortality through early detection of high-grade dysplasia (HGD) and noninvasive EAC. Although there is no convincing clinical data or conclusive evidence to support this strategy, the practice continues.
Abstract and Introduction
Abstract
Purpose of review Our article discusses the current understanding of screening and surveillance options for Barrett's esophagus and emerging concepts that have the potential to improve the effectiveness and cost-effectiveness of surveillance.
Recent findings Although endoscopic surveillance of patients with Barrett's esophagus is commonly practiced in order to detect high-grade dysplasia and early esophageal adenocarcinoma (EAC), the reported incidence of EAC in Barrett's esophagus patients varies widely. Recent studies found the risk of progression from Barrett's esophagus to EAC to be significantly lower than previously reported, raising concerns regarding the limitations of current surveillance strategies. Advances in imaging techniques and their enhanced diagnostic accuracy may improve the value of endoscopic surveillance. Additionally, various efforts are ongoing to identify biomarkers that identify individuals at higher risk of cancer, possibly allowing for individual risk stratification.
Summary These new data highlight some of the opportunities to revise and improve surveillance in patients with Barrett's esophagus. The incorporation of new advances such as imaging techniques and biomarkers has the potential to improve the effectiveness and cost-effectiveness of new surveillance regimens.
Introduction
The incidence of esophageal adenocarcinoma (EAC) has been drastically increasing over the past 40 years, particularly in Western populations. Efforts to curb this rise in EAC incidence have focused on screening for Barrett's esophagus, a precursor to EAC. Current practice has been to selectively screen individuals over the age of 50 with a history of chronic gastroesophageal reflux disease (GERD) symptoms to identify patients with Barrett's esophagus. For the patients diagnosed with Barrett's esophagus, older guidelines recommended endoscopic surveillance in an effort to reduce morbidity and mortality through early detection of high-grade dysplasia (HGD) and noninvasive EAC. Although there is no convincing clinical data or conclusive evidence to support this strategy, the practice continues.