This impressive randomized trial observed an approximately 10-fold increase in detection of Barrett's with use of the Cytosponge non-endoscopic test. Nine persons in the Cytosponge group were found to have treatable dysplasia or early stage cancer vs. none in the usual care group.
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.