Guidelines for the screening and surveillance of Barrett’s esophagus continue to evolve as the incidence of esophageal adenocarcinoma increases, identification of individuals at highest risk for cancer improves, and management of dysplasia evolves. This article reviews related studies and economic analyses. Advances in diagnosis offer promising strategies to help focus screening efforts on those individuals who are most likely to develop esophageal adenocarcinoma.
Key points
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Although there are no prospective trials confirming the effectiveness of endoscopic screening and surveillance to reduce mortality from esophageal adenocarcinoma, retrospective data suggest that individuals at elevated risk may benefit from endoscopy.
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Studies published to date rely on data generated before widespread use of endoscopic radiofrequency ablation; therefore, the impact of endoscopic treatment in the context of screening and surveillance is unknown.
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Endoscopic eradication therapy in individuals with Barrett’s esophagus and high-grade dysplasia is cost-effective compared with surveillance or no screening.
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Endoscopic eradication therapy in individuals with Barrett’s esophagus without dysplasia is not a cost-effective intervention compared with surveillance.
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Endoscopic eradication therapy in individuals with Barrett’s esophagus and low-grade dysplasia may be cost-effective compared with surveillance but this depends on the accuracy of the histopathologic diagnosis of dysplasia.
Related posts:
New Directions in Barrett’s Esophagus
The Troublesome Epidemiology of Barrett’s Esophagus and Esophageal Adenocarcinoma
Who Deserves Endoscopic Screening for Esophageal Neoplasia?
Radiofrequency Ablation of Barrett’s Esophagus
The Role of Endoscopic Ultrasound in the Management of Patients with Barrett’s Esophagus and Superficial Neoplasia
Radiofrequency Ablation of Barrett’s Esophagus
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