EMERALD in the making? A promising blood-based microRNA panel to detect oesophageal adenocarcinoma and Barrett’s oesophagus

Abstract

Screening for oesophageal adenocarcinoma (OAC), a lethal cancer, when diagnosed after the onset of symptoms, and its sole known precursor, Barrett’s oesophagus (BO), though suggested by guidelines, remains underused.1 Support for screening is underpinned by level 1 evidence demonstrating the ability of endoscopic therapy of BO dysplasia to prevent progression to OAC and the excellent survival of patients with T1 OAC treated with endoscopic therapy.2 While multifactorial, a major obstacle to screening is thought to be the need for endoscopy (which is invasive and expensive with limited access) for BO detection. This has prompted efforts to develop non-endoscopic and non-physician-administered screening tools, which could lead to greater utilisation in practice. To this end, excellent performance characteristics and safety of swallowable cell collection devices+biomarkers in detecting BO (with and without OAC/dysplasia)3 have been reported, leading to the inclusion of this technology as an alternative to endoscopy, in guidelines. In a pragmatic clinical trial, 39% of approached patients expressed interest in this strategy.4 Another study reported that up to 60% of surveyed patients expressed interest in a capsule sponge+biomarker-based test, suggesting additional advantage with minimally invasive technologies.5 To this end, Miyoshi et al report promising results of a six-microRNA (miRNA) panel assayed in peripheral blood samples in detecting the presence …