Barrett’s esophagus (BE) surveillance remains fraught with controversy and variation in real-world clinical practices. The application of current guideline-recommended surveillance intervals has not significantly impacted the incidence of esophageal adenocarcinoma (EAC), nor survival. One fifth of patients with EAC present in the first year after a negative upper endoscopy. Additionally, the progression from BE to EAC may occur in a non-linear fashion and more rapidly than previously believed due sudden genomic catastrophes requiring intensified surveillance. Emerging data supports the role of molecular markers for risk stratification and a more patient-centered surveillance approach rather than less vigorous universal surveillance intervals.
CookMBThriftAP. Epidemiology of Barrett’s esophagus and esophageal adenocarcinoma: implications for screening and surveillance. Gastrointest Endosc Clin N Am. 2021;31(1):1-26.
2.
DiSienaMPerelmanABirkJRezaizadehH. Esophageal cancer: an updated review. South Med J. 2021;114(3):161-168.
3.
SiegelRLMillerKDJemalA. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7-30.
4.
OrmsbyAHKilgoreSPGoldblumJRRichterJERiceTWGramlichTL. The location and frequency of intestinal metaplasia at the esophagogastric junction in 223 consecutive autopsies: implications for patient treatment and preventive strategies in Barrett’s esophagus. Mod Pathol. 2000;13(6):614-620.
5.
RonkainenJAroPStorskrubbT, et al. Prevalence of Barrett’s esophagus in the general population: an endoscopic study. Gastroenterology. 2005;129(6):1825-1831.
6.
HeHChenNHouY, et al. Trends in the incidence and survival of patients with esophageal cancer: a SEER database analysis. Thorac Cancer. 2020;11(5):1121-1128.
7.
StachlerMDTaylor-WeinerAPengS, et al. Paired exome analysis of Barrett’s esophagus and adenocarcinoma. Nat Genet. 2015;47(9):1047-1055.
8.
SawasTMajzoubAMHaddadJ, et al. Magnitude and time-trend analysis of postendoscopy esophageal adenocarcinoma: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2022;20(2):e31-e50.
9.
VisrodiaKSinghSKrishnamoorthiR, et al. Magnitude of missed esophageal adenocarcinoma after Barrett’s esophagus diagnosis: a systematic review and meta-analysis. Gastroenterology. 2016;150(3):599-607.e7; quiz e14.
10.
DesaiTKKrishnanKSamalaN, et al. The incidence of oesophageal adenocarcinoma in non-dysplastic Barrett’s oesophagus: a meta-analysis. Gut. 2012;61(7):970-976.
11.
ShaheenNJFalkGWIyerPGSouzaRFWaniS. Guideline to practice: Diagnosis and management of barrett’s esophagus: an updated ACG guideline. Am J Gastroenterol. 2022;117(8):1177-1180.
12.
FitzgeraldRCdi PietroMRagunathK, et al. British society of gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut. 2014;63(1):7-42.
13.
WeustenBBisschopsRCoronE, et al. Endoscopic management of Barrett’s esophagus: European Society of Gastrointestinal Endoscopy (ESGE) position statement. Endoscopy. 2017;49(2):191-198.
14.
OldOMoayyediPLoveS, et al. Barrett’s oesophagus surveillance versus endoscopy at need study (BOSS): protocol and analysis plan for a multicentre randomized controlled trial. J Med Screen. 2015;22(3):158-164.
15.
WaniSWilliamsJLFalkGWKomanduriSMuthusamyVRShaheenNJ. An analysis of the GIQuIC nationwide quality registry reveals unnecessary surveillance endoscopies in patients with normal and irregular Z-lines. Am J Gastroenterol. 2020;115(11):1869-1878.
16.
CorleyDAMehtaniKQuesenberryCZhaoWde BoerJWeissNS. Impact of endoscopic surveillance on mortality from Barrett’s esophagus-associated esophageal adenocarcinomas. Gastroenterology. 2013;145(2):312-9.e1.
17.
CooperGSYuanZChakARimmAA. Association of prediagnosis endoscopy with stage and survival in adenocarcinoma of the esophagus and gastric cardia. Cancer. 2002;95(1):32-38.
18.
El-SeragHBNaikADDuanZ, et al. Surveillance endoscopy is associated with improved outcomes of oesophageal adenocarcinoma detected in patients with Barrett’s oesophagus. Gut. 2016;65(8):1252-1260.
19.
RubensteinJHSonnenbergADavisJMcMahonLInadomiJM. Effect of a prior endoscopy on outcomes of esophageal adenocarcinoma among United States veterans. Gastrointest Endosc. 2008;68(5):849-855.
20.
TramontanoACSheehanDFYehJM, et al. The impact of a prior diagnosis of Barrett’s esophagus on esophageal adenocarcinoma survival. Am J Gastroenterol. 2017;112(8):1256-1264.
21.
InadomiJM. Surveillance in Barrett’s esophagus: a failed premise. Keio J Med. 2009;58(1):12-18.
22.
CodipillyDCChandarAKSinghS, et al. The effect of endoscopic surveillance in patients with Barrett’s esophagus: a systematic review and meta-analysis. Gastroenterology. 2018;154(8):2068-2086.e5.
23.
VerbeekREvan OijenMGten KateFJ, et al. Surveillance and follow-up strategies in patients with high-grade dysplasia in Barrett’s esophagus: a Dutch population-based study. Am J Gastroenterol. 2012;107(4):534-542.
24.
NonesKWaddellNWayteN, et al. Genomic catastrophes frequently arise in esophageal adenocarcinoma and drive tumorigenesis. Nat Commun. 2014;5:5224.
25.
CurtiusKRubensteinJHChakAInadomiJM. Computational modelling suggests that Barrett’s oesophagus may be the precursor of all oesophageal adenocarcinomas. Gut. 2021;70:1435-1440.
26.
VissapragadaRBulamuNBBrumfittCKarnonJYazbeckRWatsonDI. Improving cost-effectiveness of endoscopic surveillance for Barrett’s esophagus by reducing low-value care: a review of economic evaluations. Surg Endosc. 2021;35(11):5905-5917.
27.
PechOViethMSchmitzD, et al. Conclusions from the histological diagnosis of low-grade intraepithelial neoplasia in Barrett’s oesophagus. Scand J Gastroenterol. 2007;42(6):682-688.
28.
SinghSManickamPAminAV, et al. Incidence of esophageal adenocarcinoma in Barrett’s esophagus with low-grade dysplasia: a systematic review and meta-analysis. Gastrointest Endosc. 2014;79(6):897-909.
29.
WaniSWilliamsJLKomanduriSMuthusamyVRShaheenNJ. Endoscopists systematically undersample patients with long-segment Barrett’s esophagus: an analysis of biopsy sampling practices from a quality improvement registry. Gastrointest Endosc. 2019;90(5):732-741.e3.
30.
RedstonMNoffsingerAKimA, et al. Abnormal TP53 predicts risk of progression in patients with Barrett’s esophagus regardless of a diagnosis of dysplasia. Gastroenterology. 2022;162(2):468-481.
31.
Ross-InnesCSChettouhHAchilleosA, et al. Risk stratification of Barrett’s oesophagus using a non-endoscopic sampling method coupled with a biomarker panel: a cohort study. Lancet Gastroenterol Hepatol. 2017;2(1):23-31.
32.
JinZChengYGuW, et al. A multicenter, double-blinded validation study of methylation biomarkers for progression prediction in Barrett’s esophagus. Cancer Res. 2009;69(10):4112-4115.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
