Ireland consortium estimates progression from Barrett's to esophageal adenocarcinoma or high grade dysplasia, finding risks similar to previous studies, but higher risk among confirmed low grade dysplasias.
Michelle Hill and colleagues from the QIMR Berghofer in Queensland, AU, take a close look at non-invasive methods for collecting cells from the esophageal lining, and the role of blood-based biomarkers in risk stratification.
Transl Gastroenterol Hepatol. 2019 May 15;4:31. doi: 10.21037/tgh.2019.04.08. eCollection 2019.
To BE or not to BE: non-invasive screening for Barrett’s esophagus, dysplasia and adenocarcinoma.
Shah AK1, Joshi V2, Hartel G1, Barbour AP3, Hill MM1,3.
In conclusion, recent studies report promising results in molecular markers for non-invasive diagnosis of BE, and/or EAC. Due to the overall low incidence rate of dysplasia diagnosis and progression to EAC, multi-site collaborative studies are needed to fully evaluate the clinical utility of these markers. Critical evaluation of the clinical pathways should be conducted, to ensure the trials address actionable clinical needs and not lead to overdiagnosis and overtreatment. If an appropriate point-of-care tool could be standardized to detect at-risk BE patients, subsequently an intensive surveillance protocol for this risk group with enhanced imaging guided endoscopy could be applied to detect dysplasia and treat these patients using ablative modalities. With development and implementation of non-invasive tests and risk prediction algorithms, the ideal scenario for EAC prevention through screening may become a future reality.