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Recent Advances in Screening for Barrett’s Esophagus

  • Esophagus (PG Iyer, Section Editor)
  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Opinion statement

Purpose of review

There is a pressing need for effective strategies to halt the increase in both the incidence and mortality of esophageal adenocarcinoma (EAC). Screening for Barrett’s esophagus, which is the only known precursor of EAC, remains a ripe area for research, particularly with regard to identifying the target population, screening tools, and management of screen-detected populations. This review aims to explore in depth the rationale for screening for Barrett’s esophagus, recent biotechnological advances which may have the potential of making screening feasible, and also highlight the challenges which will have to be overcome in order make screening for BE a realistic prospect.

Recent findings

Imaging techniques such as portable transnasal endoscopy have the advantage of providing an immediate diagnosis of Barrett’s esophagus as well as other significant pathologies such as reflux esophagitis and cancer; however, larger studies in non-enriched community screening populations are required to evaluate their feasibility. The capsule sponge is a cell-sampling device coupled with a biomarker, which has been most extensively evaluated with very promising results as regards feasibility, acceptability, accuracy, and cost-effectiveness. Its effectiveness in increasing the detection of Barrett’s esophagus in primary care is currently being evaluated. Several Barrett’s esophagus risk prediction scores have been developed with variable degrees of accuracy.

Summary

Several minimally and non-invasive screening techniques have been studied including imaging and cell-sampling devices. Barrett’s risk assessment models need to be further validated in independent, relevant screening populations with clear cut-offs for recommending screening to be defined.

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Abbreviations

AUROC:

Receiver operating characteristic curve

BE:

Barrett’s esophagus

BMI:

Body mass index

EAC:

Esophageal adenocarcinoma

GERD:

Gastroesophageal reflux disease

GWAS:

Genome-wide association study

HGD:

High-grade dysplasia

LGD:

Low-grade dysplasia

LOH:

Loss of heterozygosity

LSBE:

Long-segment Barrett’s esophagus

M-BERET:

Michigan Barrett’s Esophagus pREdiction Tool

NDBE:

Non-dysplastic Barrett’s esophagus

OSA:

Obstructive sleep apnea

OR:

Odds ratio

SIM:

Small intestinal metaplasia

TFF3:

Trefoil factor 3

TNE:

Transnasal endoscopy

ECE:

Esophageal capsule endoscopy

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

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Acknowledgements

The editors would like to thank Dr. Gary Falk for taking the time to review this manuscript.

Author information

Authors and Affiliations

  1. Barrett’s Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA

    Sarmed S. Sami MRCP PhD & Prasad G. Iyer MD MS

Authors
  1. Sarmed S. Sami MRCP PhD
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  2. Prasad G. Iyer MD MS
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Contributions

Prasad G. Iyer: guarantor of this article, contributed to the design of the study, and critical review of the subsequent drafts of the manuscript.

Sarmed S. Sami: contributed to the design, literature search, and data collection and written the first draft of manuscript.

Corresponding author

Correspondence to Prasad G. Iyer MD MS.

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Conflict of interest

Sarmed S. Sami declares no conflict of interest. Prasad G. Iyer has received a grant from the National Cancer Institute (U54 CA163004).

Human and animal rights and informed consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki Declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

Additional information

This article is part of the Topical Collection on Esophagus

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Sami, S.S., Iyer, P.G. Recent Advances in Screening for Barrett’s Esophagus. Curr Treat Options Gastro 16, 1–14 (2018). https://doi.org/10.1007/s11938-018-0166-2

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