Barrett’s Esophagus: Who and How Do We Screen?

Barrett’s esophagus (BE) is the precursor of most Esophageal Adenocarcinomas (EACs) and progresses via the development of dysplasia. Hence BE screening is recommended by gastroenterology societies in patients with risk factors. Endoscopic surveillance enables the detection of dysplasia and early stage EAC, which can be treated successfully endoscopically, reducing the incidence and mortality of EAC. Despite these recommendations, only 10% of all EACs are detected in a surveillance program, and only a third or less of all BE cases are diagnosed.

While cost associated with endoscopic screening is a barrier to screening those with risk factors, non-endoscopic cell-collection devices combined with biomarkers, namely Cytosponge-TFF3 and EsophaCap/EsoChek-MDM, are effective alternatives that may allow cost-effective screening in this population. Current guidelines which recommend screening in only those with GERD and other risk factors have been found to be poorly sensitive for BE and EAC given the substantial prevalence of BE in those without GERD. Hence several prediction models to enable the identification of those at risk for BE/EAC with moderate accuracy have been developed.

Future guidelines and risk prediction models for BE screening should include patients without GERD. BE prediction models encompassing multiple risk factors should be integrated into electronic health records to automatically identify patients at high risk. Cytosponge-TFF3 or EsophaCap/EsoChek-MDM, with subsequent diagnostic endoscopy in those with positive tests, can then be performed. Future studies to investigate whether this approach improves higher rates of BE/EAC screening and detection are warranted.