Endoscopic screening and surveillance for Barrett's esophagus: Can claims data determine its effectiveness?

During the past several decades, while the incidence of esophageal adenocarcinoma (EAC) has risen dramatically, our primary EAC-prevention strategies have been endoscopic screening of individuals with GERD symptoms for Barrett’s esophagus (BE), and endoscopic surveillance for those found to have BE. Unfortunately, current screening practices have failed to identify most patients who develop EAC, and the efficacy of surveillance remains highly questionable. We review potential reasons for failure of these practices including recent evidence that most EACs develop through a rapid genomic doubling pathway, and recent data suggesting that many EACs develop from segments of esophageal intestinal metaplasia too short to be recognized as BE. We highlight need for a biomarker to identify BE patients at high risk for neoplasia (who would benefit from early therapeutic intervention), and BE patients at low risk (who would not benefit from surveillance). Promising recent efforts to identify such a biomarker are reviewed herein.

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A Practical Approach to Screening and Surveillance of Barrett’s Esophagus

Foregut: The Journal of the American Foregut Society ◽

10.1177/2634516121993675 ◽

2021 ◽

Vol 1 (1) ◽

pp. 25-31

Author(s):

Srinadh Komanduri ◽

Domenico A. Farina

Keyword(s):

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

New Technologies ◽

Endoscopic Surveillance ◽

Segment Length ◽

Innovative Technology ◽

High Morbidity ◽

Endoscopic Screening ◽

Screening Practices ◽

Screening And Surveillance

Barrett’s esophagus (BE) can progress to Esophageal Adenocarcinoma (EAC), which has associated high morbidity and mortality. As such, societal guidelines suggest endoscopic screening in select individuals with multiple BE risk factors. However, cheaper and less invasive new technologies may allow for more widespread BE screening practices in the future. In patients with established BE, endoscopic surveillance is recommended with intervals based primarily on histology and to a lesser degree, BE segment length. Similar to BE screening, endoscopic surveillance can further be optimized with improved techniques, innovative technology, and further understanding of risk stratification for EAC.

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Risk Prediction of Barrett’s Esophagus in a Taiwanese Health Examination Center Based on Regression Models

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18105332 ◽

2021 ◽

Vol 18 (10) ◽

pp. 5332

Author(s):

Po-Hsiang Lin ◽

Jer-Guang Hsieh ◽

Hsien-Chung Yu ◽

Jyh-Horng Jeng ◽

Chiao-Lin Hsu ◽

...

Keyword(s):

Barrett’S Esophagus ◽

Risk Prediction ◽

Barrett's Esophagus ◽

Gastrointestinal Endoscopy ◽

Prediction Models ◽

Upper Gastrointestinal Endoscopy ◽

Health Examination ◽

Endoscopic Screening ◽

Risk Prediction Models ◽

Upper Gastrointestinal

Determining the target population for the screening of Barrett’s esophagus (BE), a precancerous condition of esophageal adenocarcinoma, remains a challenge in Asia. The aim of our study was to develop risk prediction models for BE using logistic regression (LR) and artificial neural network (ANN) methods. Their predictive performances were compared. We retrospectively analyzed 9646 adults aged ≥20 years undergoing upper gastrointestinal endoscopy at a health examinations center in Taiwan. Evaluated by using 10-fold cross-validation, both models exhibited good discriminative power, with comparable area under curve (AUC) for the LR and ANN models (Both AUC were 0.702). Our risk prediction models for BE were developed from individuals with or without clinical indications of upper gastrointestinal endoscopy. The models have the potential to serve as a practical tool for identifying high-risk individuals of BE among the general population for endoscopic screening.

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