Screening for Barrett’s Oesophagus: Are We Ready for it?

Abstract

Purpose of review The targeted approach adopted for Barrett’s oesophagus (BO) screening is sub-optimal considering the large proportion of BO cases that are currently missed. We reviewed the literature highlighting recent technological advancements in efforts to counteract this challenge. We also provided insights into strategies that can improve the outcomes from current BO screening practises. Recent findings The standard method for BO detection, endoscopy, is invasive and expensive and therefore inappropriate for mass screening. On the other hand, endoscopy is more cost-effective for screening a high-risk population. A consensus has however not been reached on who should be screened. Risk prediction algorithms have been tested as an enrichment pre-screening tool reporting modest AUC’s but require more prospective evaluation studies. Less invasive endoscopy methods like trans-nasal endoscopy, oesophageal capsule endsocopy and non-endoscopic cell collection devices like the Cytosponge coupled with biomarker analysis have shown promise in BO detection with randomised clinical trial evidence. Summary A three-tier precision cancer programme whereby risk prediction algorithms and non-endoscopic minimally invasive cell collection devices are used to triage test a wider pool of individuals may improve the detection rate of current screening practises with minimal cost implications.

Patient Factors Associated With Gastroesophageal Reflux Disease Diagnostic Evaluation Strategies: A Retrospective Cohort Study Using Real-World Evidence From a Large U.S. Medical Claims Database

“…30 Furthermore, if these risk stratification tools are coupled with emerging novel screening modalities that do not require sedation, it may be possible to offer cost-effective BE screening to more patients. 16 For example, a recent randomized control trial demonstrated that a BE screening program based on the cell collection device cytosponge trefoil factor 3 identified 10 times more cases of BE compared to usual care in general practices in the United Kingdom. 31 This study has several strengths that lend credibility to its conclusions.…”

“…These include upper endoscopy risk stratification algorithms and nonendoscopic BE screening modalities, such as minimally invasive cell collection devices, unsedated transnasal endoscopy, and exhaled volatile organic acids. [14][15][16] As 40% of patients with EAC present at a distant stage, which has a survival rate 9 times worse than that of localized EAC, 1 these novel BE screening strategies have the potential to vastly improve the morbidity and mortality of EAC by inducing a stage shift. As PCPs are often the first practitioners to diagnose and manage GERD, understanding their current practice patterns may provide key insights about knowledge, attitudes, and barriers to BE screening that could guide the development and implementation of future BE screening programs.…”

Expanding beyond endoscopy: A review of non-invasive modalities in Barrett’s esophagus screening and surveillance

“…The Cytosponge (Medtronic, Minneapolis, MN, Figure 4 ) is a 30 mm polyurethane sponge, compressed withing a gelatin capsule and attached to a string[ 13 ]. Once patient swallows the capsule and it reaches the stomach, the capsule opens up and reveals the sponge.…”

“…EsoCheck (Lucid Diagnostics, New York, NY, Figure 6 ) is a balloon-based sampling device which consists of a collapsible balloon attached to thin silicone catheter connected to a syringe[ 13 ]. Once EsoCheck is swallowed and is in the stomach, the balloon is inflated by injecting air into the catheter and withdrawn through the distal 3-6 cm of the esophagus, collecting epithelial cells.…”

“…This provides an excellent opportunity for non-endoscopic techniques to be used as a public health tool for screening (identification of disease) and surveillance. Individuals belonging to the low risk BE strata are best suited for non-endoscopic modalities as they require minimal intervention whereas the high risk BE group would require more precise but also more invasive endoscopic based technologies[ 13 ]. Non-endoscopic techniques provide cost-effective, less invasive screening tools and more importantly increase the ease of accessibility to screening opportunities.…”