Esophageal adenocarcinoma (EAC) is rising in incidence and has a poor 5-year survival. Decades of targeted screening for Barrett’s esophagus (BE), the precursor to EAC, have not appreciably reduced EAC incidence. Here, we review the drawbacks of the current screening paradigm, including overreliance on GERD symptoms and sedated upper endoscopy. We debate the merits of a universal BE screening program. We propose an ideal BE screening strategy combining novel risk stratification models and non-invasive screening techniques to expand selective screening to patients without GERD, but at elevated risk for BE.
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