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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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