The Horizon of Screening for Barrett's Esophagus and Esophageal Cancer

Barrett's esophagus (BE) is a premalignant precursor to esophageal adenocarcinoma (EAC), a cancer whose incidence has increased sixfold in the Western world over the past 3 decades. The prognosis associated with EAC remains poor, with the 5-year survival estimated to be < 20%. Epidemiological and clinical study evidence has suggested that early detection and treatment of BE-related neoplasia is associated with improved survival, suggesting that screening for this condition could impact EAC survival. Over the past few decades, there have been accelerated advances in the field of BE and EAC, particularly in the emergence of non-endoscopic cell-collection devices that could be used for screening. In this review, we critically discuss the concept of screening BE and EAC, as well as identifying the target population who should be screened. We then review the evidence for various cell-collection devices that could be used for screening in the office-based setting, such as screenig using prediction models, transnasal endoscopy (TNE), Cytosponge and biomarker Trefoil-factor 3 (TFF3), EsophaCap and methylated DNA markers (MDMs), and the balloon-based EsoCheck and MDMs. We also discuss other novel technologies, such as volatile organic compound detection using the electric nose and technologies using optical coherence tomography. These promising technologies have paved the way for the potential introduction of a screening program for BE and EAC, with the hope that this could lead to improved outcomes among patients who suffer from this unfortunate disease.