New Screening Techniques in Barrett’s Esophagus: Great Ideas or Great Practice?

      A number of lines of evidence suggest that Barrett’s metaplasia is a risk factor for esophageal adenocarcinoma (EAC). To prevent deaths from this tumor, medical societies in countries around the world have recommended screening for and surveillance of Barrett’s esophagus.
      • Spechler S.J.
      • Sharma P.
      • et al.
      American Gastroenterological Association
      American Gastroenterological Association medical position statement on the management of Barrett's esophagus.
      • Shaheen N.J.
      • Falk G.W.
      • Iyer P.G.
      • et al.
      American College of Gastroenterology. ACG clinical guideline: diagnosis and management of Barrett's esophagus.
      • Fitzgerald R.C.
      • di Pietro M.
      • Ragunath K.
      • et al.
      British Society of Gastroenterology. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus.
      However, the majority of Barrett’s is undiagnosed and compliance with this advice and the adherence to standardized protocols is highly variable among physicians and patients. As a result the impact of screening and surveillance on population-based mortality from this cancer is negligible. Owing to the low incidence of this cancer, compared with cancers such as breast or colon, population-based screening with endoscopy for the purpose of ongoing surveillance has not been recommended except in those with multiple risk factors including a high body mass index, male gender, white race, chronic reflux, and family history. To date, it is not proven that endoscopic screening is beneficial and there are downsides that need to be considered, including the fiscal and psychological costs as well as the possibility of adverse events.
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        • Spechler S.J.
        • Sharma P.
        • et al.
        • American Gastroenterological Association
        American Gastroenterological Association medical position statement on the management of Barrett's esophagus.
        Gastroenterology. 2011; 140: 1084-1091
        • Shaheen N.J.
        • Falk G.W.
        • Iyer P.G.
        • et al.
        American College of Gastroenterology. ACG clinical guideline: diagnosis and management of Barrett's esophagus.
        Am J Gastroenterol. 2016; 111: 30-50
        • Fitzgerald R.C.
        • di Pietro M.
        • Ragunath K.
        • et al.
        British Society of Gastroenterology. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus.
        Gut. 2014; 63: 7-42
        • El-Serag H.B.
        • Naik A.D.
        • Duan Z.
        • et al.
        Surveillance endoscopy is associated with improved outcomes of oesophageal adenocarcinoma detected in patients with Barrett's oesophagus.
        Gut. 2016; 65: 1252-1260
        • Qiao Y.
        • Hyder A.
        • Bae S.J.
        • et al.
        Surveillance in patients with Barrett's esophagus for early detection of esophageal adenocarcinoma: a systematic review and meta-analysis.
        Clin Transl Gastroenterol. 2015; 6: e131
        • Shaheen N.J.
        • Provenzale D.
        • Sandler R.S.
        Upper endoscopy as a screening and surveillance tool in esophageal adenocarcinoma: a review of the evidence.
        Am J Gastroenterol. 2002; 97: 1319-1327
        • Corley D.A.
        • Mehtani K.
        • Quesenberry C.
        • et al.
        Impact of endoscopic surveillance on mortality from Barrett's esophagus-associated esophageal adenocarcinomas.
        Gastroenterology. 2013; 145: 31231-31239
        • Dulai G.S.
        • Guha S.
        • Kahn K.L.
        • et al.
        Preoperative prevalence of Barrett’s esophagus in esophageal adenocarcinoma: a systematic review.
        Gastroenterology. 2001; 122: 26-33
        • Bhat S.K.
        • McManus D.T.
        • Coleman H.G.
        • et al.
        Oesophageal adenocarcinoma and prior diagnosis of Barrett's oesophagus: a population-based study.
        Gut. 2015; 64: 20-25
        • Chak A.
        • Faulx A.
        • Eng C.
        • et al.
        Gastroesophageal reflux symptoms in patients with adenocarcinoma of the esophagus or cardia.
        Cancer. 2006; 107: 2160-2166
        • Rex D.K.
        • Cummings O.W.
        • Shaw M.
        • et al.
        Screening for Barrett's esophagus in colonoscopy patients with and without heartburn.
        Gastroenterology. 2003; 125: 1670-1677
        • Thrift A.P.
        • Kendall B.J.
        • Pandeya N.
        • et al.
        A model to determine absolute risk for esophageal adenocarcinoma.
        Clin Gastroenterol Hepatol. 2013; 11: 138-144 e2
        • Rubenstein J.H.
        • Thrift A.P.
        Risk factors and populations at risk: selection of patients for screening for Barrett's oesophagus.
        Best Pract Res Clin Gastroenterol. 2015; 29: 41-50
        • Rubenstein J.H.
        • Morgenstern H.
        • Appelman H.
        • et al.
        Prediction of Barrett's esophagus among men.
        Am J Gastroenterol. 2013; 108: 353-362
        • Sami S.S.
        • Dunagan K.T.
        • Johnson M.L.
        • et al.
        A randomized comparative effectiveness trial of novel endoscopic techniques and approaches for Barrett's esophagus screening in the community.
        Am J Gastroenterol. 2015; 110: 148-158
        • Shariff M.K.
        • Bird-Lieberman E.L.
        • O'Donovan M.
        • et al.
        Randomized crossover study comparing efficacy of transnasal endoscopy with that of standard endoscopy to detect Barrett's esophagus.
        Gastrointest Endosc. 2012; 75: 954-961
        • Shariff M.K.
        • Varghese S.
        • O'Donovan M.
        • et al.
        Pilot randomized crossover study comparing the efficacy of transnasal disposable endosheath with standard endoscopy to detect Barrett's esophagus.
        Endoscopy. 2016; 48: 110-116
        • Peery A.F.
        • Hoppo T.
        • Garman K.S.
        • et al.
        • Barrett's Esophagus Risk Consortium
        Feasibility, safety, acceptability, and yield of office-based, screening transnasal esophagoscopy (with video).
        Gastrointest Endosc. 2012; 75: 945-953
        • Sami S.S.
        • Subramanian V.
        • Ortiz-Fernandez-Sordo J.
        • et al.
        Performance characteristics of unsedated ultrathin video endoscopy in the assessment of the upper GI tract: systematic review and meta-analysis.
        Gastrointest Endosc. 2015; 82: 782-792
        • Sugimoto H.
        • Kawai T.
        • Naito S.
        • et al.
        Surveillance of short-segment Barrett's esophagus using ultrathin transnasal endoscopy.
        J Gastroenterol Hepatol. 2015; 30: 41-45
        • Alashkar B.
        • Faulx A.L.
        • Hepner A.
        • et al.
        Development of a program to train physician extenders to perform transnasal esophagoscopy and screen for Barrett's esophagus.
        Clin Gastroenterol Hepatol. 2014; 12: 785-792
        • Bhardwaj A.
        • Hollenbeak C.S.
        • Pooran N.
        • et al.
        A meta-analysis of the diagnostic accuracy of esophageal capsule endoscopy for Barrett's esophagus in patients with gastroesophageal reflux disease.
        Am J Gastroenterol. 2009; 104: 1533-1539
        • Ramirez F.C.
        • Akins R.
        • Shaukat M.
        Screening of Barrett's esophagus with string-capsule endoscopy: a prospective blinded study of 100 consecutive patients using histology as the criterion standard.
        Gastrointest Endosc. 2008; 68: 25-31
        • Galmiche J.P.
        • Sacher-Huvelin S.
        • Coron E.
        • et al.
        Screening for esophagitis and Barrett's esophagus with wireless esophageal capsule endoscopy: a multicenter prospective trial in patients with reflux symptoms.
        Am J Gastroenterol. 2008; 103: 538-545
        • Chavalitdhamrong D.
        • Chen G.C.
        • Roth B.E.
        • et al.
        Esophageal capsule endoscopy for evaluation of patients with chronic gastroesophageal reflux symptoms: findings and its image quality.
        Dis Esophagus. 2011; 24: 295-298
        • Waterman M.
        • Gralnek I.M.
        Capsule endoscopy of the esophagus.
        J Clin Gastroenterol. 2009; 43: 605-612
        • Gora M.J.
        • Sauk J.S.
        • Carruth R.W.
        • et al.
        Tethered capsule endomicroscopy enables less invasive imaging of gastrointestinal tract microstructure.
        Nat Med. 2013; 19: 238-240
        • Lao-Sirieix P.
        • Boussioutas A.
        • Kadri S.R.
        • et al.
        Non-endoscopic screening biomarkers for Barrett's oesophagus: from microarray analysis to the clinic.
        Gut. 2009; 58: 1451-1459
        • Ross-Innes C.S.
        • Debiram-Beecham I.
        • O'Donovan M.
        • et al.
        Evaluation of a minimally invasive cell sampling device coupled with assessment of trefoil factor 3 expression for diagnosing Barrett's esophagus: a multi-center case-control study.
        PLoS Med. 2015; 12: e1001780
        • Lao-Sirieix P.
        • Rous B.
        • O'Donovan M.
        • et al.
        Non-endoscopic immunocytological screening test for Barrett's oesophagus.
        Gut. 2007; 56: 1033-1034
        • Kadri S.
        • Lao-Sirieix P.
        • Fitzgerald R.C.
        Developing a nonendoscopic screening test for Barrett's esophagus.
        Biomark Med. 2011; 5: 397-404
        • Kadri S.R.
        • Lao-Sirieix P.
        • O'Donovan M.
        • et al.
        Acceptability and accuracy of a non-endoscopic screening test for Barrett's oesophagus in primary care: cohort study.
        BMJ. 2010; 341: c4372
        • Lao-Sirieix P.
        • Bebiram-Beecham I.
        • Gadeke L.
        • et al.
        Evaluation of a minimally-invasive cytosponge esophageal cell collection system in patients with Barrett's esophagus.
        Gastroenterology. 2015; 148 (S-16)
        • Chettouh H.
        • Mowforth O.
        • Galeano-Dalmau N.
        • et al.
        Methylation panel is a diagnostic biomarker for Barrett's oesophagus in endoscopic biopsies and non-endoscopic cytology specimens.
        Gut. 2017; ([Epub ahead of print])
        • Katz-Summercorn A.
        • Anand S.
        • Ingledew S.
        • et al.
        Application of a multi-gene next-generation sequencing panel to a non-invasive oesophageal cell-sampling device to diagnose dysplastic Barrett's oesophagus.
        J Pathol Clin Res. 2017; 3: 258-267
        • Heberle C.R.
        • Omidvari A.H.
        • Ali A.
        • et al.
        Cost effectiveness of screening patients with gastroesophageal reflux disease for Barrett's esophagus with a minimally invasive cell sampling device.
        Clin Gastroenterol Hepatol. 2017; 15: 1397-1404 e7
        • Benaglia T.
        • Sharples L.D.
        • Fitzgerald R.C.
        • et al.
        Health benefits and cost effectiveness of endoscopic and nonendoscopic cytosponge screening for Barrett's esophagus.
        Gastroenterology. 2013; 144: 62-73 e6
        • Mitchell P.S.
        • Parkin R.K.
        • Kroh E.M.
        • et al.
        Circulating microRNAs as stable blood-based markers for cancer detection.
        Proc Natl Acad Sci U S A. 2008; 105: 10513-10518
        • Calin G.A.
        • Croce C.M.
        MicroRNA signatures in human cancers.
        Nat Rev Cancer. 2006; 6: 857-866
        • Farazi T.A.
        • Hoell J.I.
        • Morozov P.
        • et al.
        MicroRNAs in human cancer.
        Adv Exp Med Biol. 2013; 774: 1-20
        • Mallick R.
        • Patnaik S.K.
        • Wani S.
        • et al.
        A systematic review of esophageal microRNA markers for diagnosis and monitoring of Barrett's esophagus.
        Dig Dis Sci. 2016; 61: 1039-1050
        • Cabibi D.
        • Caruso S.
        • Bazan V.
        • et al.
        Analysis of tissue and circulating microRNA expression during metaplastic transformation of the esophagus.
        Oncotarget. 2016; 7: 47821-47830
        • Bus P.
        • Kestens C.
        • Ten Kate F.J.
        • et al.
        Profiling of circulating microRNAs in patients with Barrett's esophagus and esophageal adenocarcinoma.
        J Gastroenterol. 2016; 51: 560-570
        • Yazbeck R.
        • Jaenisch S.E.
        • Watson D.I.
        From blood to breath: new horizons for esophageal cancer biomarkers.
        World J Gastroenterol. 2016; 22: 10077-10083
        • Chandar A.K.
        • Devanna S.
        • Lu C.
        • et al.
        Association of serum levels of adipokines and insulin with risk of Barrett's esophagus: a systematic review and meta-analysis.
        Clin Gastroenterol Hepatol. 2015; 13 (e1–4; quiz e179): 2241-2255
        • Kumar S.
        • Huang J.
        • Abbassi-Ghadi N.
        • Mackenzie H.A.
        • et al.
        Mass spectrometric analysis of exhaled breath for the identification of volatile organic compound biomarkers in esophageal and gastric adenocarcinoma.
        Ann Surg. 2015; 262: 981-990
        • Chan D.K.
        • Zakko L.
        • Visrodia K.H.
        • et al.
        Breath testing for Barrett's esophagus using exhaled volatile organic compound profiling with an electronic nose device.
        Gastroenterology. 2017; 152: 24-26
        • Rubenstein J.H.
        • Inadomi J.M.
        • et al.
        Cost utility of screening for Barrett's esophagus with esophageal capsule endoscopy versus conventional upper endoscopy.
        Clin Gastroenterol Hepatol. 2007; 5: 312-318
        • Moriarty J.P.
        • Shah N.D.
        • Rubenstein J.H.
        • et al.
        Costs associated with Barrett's esophagus screening in the community: an economic analysis of a prospective randomized controlled trial of sedated versus hospital unsedated versus mobile community unsedated endoscopy.
        Gastrointest Endosc. 2018; 87: 88-94.e2
        • Rubenstein J.H.
        • Taylor J.B.
        Meta-analysis: the association of oesophageal adenocarcinoma with symptoms of gastro-oesophageal reflux.
        Aliment Pharmacol Ther. 2010; 32: 1222-1227 21
        • Lagergren J.
        • Bergstrom R.
        • Lindgren A.
        • et al.
        Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma.
        N Engl J Med. 1999; 340: 825-831
        • Farrow D.C.
        • et al.
        Gastroesophageal reflux disease, use of H2 receptor antagonists, and risk of esophageal and gastric cancer.
        Cancer Causes Control. 2000; 11: 231-238
        • Dent J.
        • El-Serag H.B.
        • Wallander M.A.
        • et al.
        Epidemiology of gastro-oesophageal reflux disease: a systematic review.
        Gut. 2005; 54: 710-717
        • Cook M.B.
        • et al.
        Gastroesophageal reflux in relation to adenocarcinomas of the esophagus: a pooled analysis from the Barrett’s and Esophageal Adenocarcinoma Consortium (BEACON) PLoS ONE.
        . 2014; 9: e103508
        • Janmaat V.T.
        • van Olphen S.H.
        • Biermann K.E.
        • et al.
        Use of immunohistochemical biomarkers as independent predictor of neoplastic progression in Barrett's oesophagus surveillance: a systematic review and meta-analysis.
        PLoS One. 2017; 12: e0186305
        • Tachler M.D.
        • Taylor-Weiner A.
        • Peng S.
        • et al.
        Paired exome analysis of Barrett's esophagus and adenocarcinoma.
        Nat Genet. 2015; 47: 1047-1055