What Is the Optimal Surveillance Strategy for Non-dysplastic Barrett’s Esophagus?

Abstract

Purpose of review

There is conflicting data on the effectiveness of the currently recommended endoscopic surveillance strategy in non-dysplastic Barrett’s esophagus (BE) patients. We reviewed the literature to evaluate the (cost) effectiveness of the current surveillance strategy. We also reviewed critical strategies and new technologies that could improve dysplasia detection.

Recent findings

Adherence to the current EGD surveillance guidelines is suboptimal with high rates of missed dysplasia/esophageal adenocarcinoma (EAC). The influence of surveillance on EAC mortality appears modest. Careful cleansing, inspection, and sampling of the BE mucosa using high-resolution white light (electronic) chromoendoscopy are critical. Newer sampling techniques coupled with computer aided diagnosis and emerging imaging technologies have shown promise in improving dysplasia detection. Personalized surveillance with risk stratification based on risk factors for progression may be on the horizon.

Summary

Current BE surveillance strategy will likely be further refined and optimized by emerging new technologies in tissue sampling, advanced imaging, and risk stratification.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Funding

Supported in part by NCI R01 grant CA 241064 (to PGI).

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Correspondence to Prasad G. Iyer MD MSc.

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Gibbens, Y., Iyer, P.G. What Is the Optimal Surveillance Strategy for Non-dysplastic Barrett’s Esophagus?. Curr Treat Options Gastro (2020). https://doi.org/10.1007/s11938-020-00297-9

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Keywords

  • Barrett’s esophagus
  • Esophageal adenocarcinoma
  • Endoscopic surveillance
  • Cancer progression
  • Risk stratification
  • Artificial intelligence