Three-tiered screening program proposed

Drs. Yusuf and Fitzgerald review recent technological advancements in screening for Barrett's esophagus and propose a three-tier approach using risk prediction algorithms and minimally invasive approaches to improving detection rate for Barrett's and EAC

Curr Treat Options Gastroenterol. 2021 Mar 16;1-16.

doi: 10.1007/s11938-021-00342-1. Online ahead of print.

PMID: 33746508 PMCID: PMC7962426

Screening for Barrett's Oesophagus: Are We Ready for it?

Aisha Yusuf, Rebecca C Fitzgerald



Purpose of review: The targeted approach adopted for Barrett's oesophagus (BO) screening is sub-optimal considering the large proportion of BO cases that are currently missed. We reviewed the literature highlighting recent technological advancements in efforts to counteract this challenge. We also provided insights into strategies that can improve the outcomes from current BO screening practises.

Recent findings: The standard method for BO detection, endoscopy, is invasive and expensive and therefore inappropriate for mass screening. On the other hand, endoscopy is more cost-effective for screening a high-risk population. A consensus has however not been reached on who should be screened. Risk prediction algorithms have been tested as an enrichment pre-screening tool reporting modest AUC's but require more prospective evaluation studies. Less invasive endoscopy methods like trans-nasal endoscopy, oesophageal capsule endsocopy and non-endoscopic cell collection devices like the Cytosponge coupled with biomarker analysis have shown promise in BO detection with randomised clinical trial evidence.

Summary: A three-tier precision cancer programme whereby risk prediction algorithms and non-endoscopic minimally invasive cell collection devices are used to triage test a wider pool of individuals may improve the detection rate of current screening practises with minimal cost implications.

This website contains a curated and opinionated look at recent literature regarding the epidemiology and prevention of esophageal cancer, with an emphasis on esophageal adenocarcinoma. It is developed by Thomas L Vaughan MD, MPH ©2021
This website should not be considered, or used as a substitute for, medical advice, diagnosis or treatment. This site does not constitute the practice of any medical or other professional health care advice, diagnosis or treatment. The information on this website represent the views solely of Dr. Vaughan.
Cookies are used solely to quantify website use for resource planning. Complete IP addresses are not collected (i.e., will be recorded as 203.0.113.??) Feel free to opt out of cookies using add-ins of your choice without affecting website function. No user information is collected by the risk calculator (IC-RISC).