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

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.

Download Full-text

Implications of Recent Revelations from Basic and Clinical Studies of Barrett’s Esophagus for Screening and Surveillance Strategies

Foregut: The Journal of the American Foregut Society ◽

10.1177/2634516121990959 ◽

2021 ◽

Vol 1 (1) ◽

pp. 86-92

Author(s):

Stuart Jon Spechler ◽

Rhonda F. Souza

Keyword(s):

High Risk ◽

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Prevention Strategies ◽

Endoscopic Screening ◽

Screening Practices ◽

The Past ◽

Screening And Surveillance ◽

Gerd Symptoms ◽

Current Screening

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.

Download Full-text

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

Gastrointestinal Endoscopy ◽

10.1016/s0016-5107(03)70029-7 ◽

2003 ◽

Vol 57 (7) ◽

pp. 914-916 ◽

Cited By ~ 14

Author(s):

Gregory S. Cooper

Keyword(s):

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Claims Data ◽

Endoscopic Screening ◽

Screening And Surveillance

Download Full-text

Recommendations for endoscopic surveillance after esophageal atresia repair in adults

Diseases of the Esophagus ◽

10.1093/dote/doab095 ◽

2022 ◽

Author(s):

Chantal A ten Kate ◽

Anne-Fleur R L van Hal ◽

Nicole S Erler ◽

Michail Doukas ◽

Suzan Nikkessen ◽

...

Keyword(s):

Esophageal Carcinoma ◽

Barrett’S Esophagus ◽

Esophageal Atresia ◽

Barrett's Esophagus ◽

Colon Interposition ◽

Endoscopic Surveillance ◽

Surveillance Strategy ◽

Endoscopic Screening ◽

Histopathological Results

SUMMARY Background Endoscopic surveillance of adults with esophageal atresia is advocated, but the optimal surveillance strategy remains uncertain. This study aimed to provide recommendations on appropriate starting age and intervals of endoscopic surveillance in adults with esophageal atresia. Methods Participants underwent standardized upper endoscopies with biopsies. Surveillance intervals of 3–5 years were applied, depending on age and histopathological results. Patient’s age and time to development of (pre)malignant lesions were calculated. Results A total of 271 patients with esophageal atresia (55% male; median age at baseline endoscopy 26.7 (range 15.6–68.5) years; colon interposition n = 17) were included. Barrett’s esophagus was found in 19 (7%) patients (median age 32.3 (17.8–56.0) years at diagnosis). Youngest patient with a clinically relevant Barrett’s esophagus was 20.9 years. Follow-up endoscopies were performed in 108 patients (40%; median follow-up time 4.6 years). During surveillance, four patients developed Barrett’s esophagus but no dysplasia or cancer was found. One 45-year-old woman with a colon interposition developed an adenoma with high-grade dysplasia which was radically removed. Two new cases of esophageal carcinoma were diagnosed in patients (55 and 66 years old) who were not under surveillance. One of them had been curatively treated for esophageal carcinoma 13 years ago. Conclusions This study shows that endoscopic screening of patients with esophageal atresia, including those with a colon interposition, can be started at 20 years of age. Up to the age of 40 years a surveillance interval of 10 years appeared to be safe. Endoscopic surveillance may also be warranted for patients after curative esophageal cancer treatment.

Download Full-text

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.

Download Full-text

Improving cost-effectiveness of endoscopic surveillance for Barrett’s esophagus by reducing low-value care: a review of economic evaluations

Surgical Endoscopy ◽

10.1007/s00464-021-08646-0 ◽

2021 ◽

Author(s):

Ravi Vissapragada ◽

Norma B. Bulamu ◽

Christine Brumfitt ◽

Jonathan Karnon ◽

Roger Yazbeck ◽

...

Keyword(s):

Cost Effectiveness ◽

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Endoscopic Surveillance ◽

Economic Evaluations

Download Full-text

Optical Detection and Eradication of Dysplastic Barrett's Esophagus

Technology in Cancer Research & Treatment ◽

10.1177/153303460300200403 ◽

2003 ◽

Vol 2 (4) ◽

pp. 289-302 ◽

Cited By ~ 7

Author(s):

Louis-Michel Wong Kee Song ◽

Kenneth K. Wang

Keyword(s):

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Sampling Error ◽

Imaging Techniques ◽

Standard Of Care ◽

Diagnostic Techniques ◽

Endoscopic Surveillance ◽

Current Status ◽

Delay In Diagnosis ◽

Multiple Biopsies

Dysplastic Barrett's esophagus is a condition that offers multiple diagnostic and therapeutic challenges. The diagnosis of dysplasia within Barrett's esophagus currently relies on periodic endoscopic surveillance with multiple biopsies, a methodology limited by random sampling error, inconsistent histopathologic interpretation and delay in diagnosis. Optical spectroscopic and imaging techniques have the potential to identify dysplastic or early neoplastic lesions in real-time. These diagnostic modalities are needed to enhance the endoscopic surveillance of Barrett's esophagus in the future as well as help to define lesions for endoscopic therapy. Esophagectomy has been the standard of care for Barrett's esophagus with high-grade dysplasia although it is a procedure associated with significant morbidity and mortality. Minimally invasive endoscopic ablative therapies are attractive and less morbid alternatives to esophagectomy, with promising results obtained from the use of light-activated drugs (i.e., photodynamic therapy). The combination of novel optical diagnostic techniques and therapies will provide the endoscopist with much needed tools that can considerably enhance the management of patients with Barrett's esophagus. This article reviews the current status and future prospects of optical-based modalities for diagnosis and therapy of dysplastic Barrett's esophagus.

Download Full-text