Who Deserves Endoscopic Screening for Esophageal Neoplasia?

Despite the availability of safe and effective endoscopic treatment of Barrett’s esophagus (BE)–related dysplasia and neoplasia, the incidence and mortality from esophageal adenocarcinoma (EAC) have continued to increase. This likely stems from the large population of patients that develop EAC outside of a BE screening and surveillance program. Identification of BE with screening followed by enrollment in an appropriate surveillance/risk stratification program could be a strategy to address both the incidence of and mortality from EAC. This article summarizes the rationale and challenges for BE screening, the risk factors for BE, and the currently described BE risk assessment tools.

Key points

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Barrett’s esophagus (BE) is regarded as the precursor to most esophageal adenocarcinomas (EAC).
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EAC that is diagnosed while in a BE surveillance program (constituting <10% of all EAC) likely has better outcomes compared with EAC diagnosed after the onset of symptoms (constituting >90% of all cases).
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Most BE in the community remains undetected despite increasing endoscopy volumes, likely due to the absence of widespread targeted screening.
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Given the prevalence of BE in the population is likely less than 10%, many BE risk assessment scores have been proposed, using known risk factors for BE. Most have not been validated in independent cohorts, and threshold for recommending screening is not yet defined.
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Validation of these scores in independent populations, defining the threshold for proceeding with screening followed by their utilization for targeting those at risk may help in making BE/EAC screening more efficient and effective.