Advances in Screening for Barrett’s Esophagus and Esophageal Adenocarcinoma

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Advances in Screening for Barrett’s Esophagus and Esophageal Adenocarcinoma

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Joel Rubenstein, MD, MS

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References
  1. Vantanasiri K, Kamboj AK, Kisiel JB, Iyer PG. Advances in Screening for Barrett Esophagus and Esophageal Adenocarcinoma. Mayo Clin Proc. 2024;99(3):459-473. doi:10.1016/j.mayocp.2023.07.014
  2. Cancer Stat Facts: Esophageal Cancer. NIH National Cancer Institute: Survival, Epidemiology, and End Results Program web site. Accessed March 12, 2025. https://seer.cancer.gov/statfacts/html/esoph.html
  3. Seer*Explorer: Esophagus. NIH National Cancer Institute: Survival, Epidemiology, and End Results Program web site. Accessed March 4, 2025. https://seer.cancer.gov/statistics-network/explorer/application.html
  4. Kolb JM, Chen M, Tavakkoli A, et al. Understanding Compliance, Practice Patterns, and Barriers Among Gastroenterologists and Primary Care Providers Is Crucial for Developing Strategies to Improve Screening for Barrett’s Esophagus. Gastroenterology. 2022;162(6):1568-1573.e4. doi:10.1053/j.gastro.2022.02.003
  5. Kunzmann AT, Thrift AP, Cardwell CR, et al. Model for Identifying Individuals at Risk for Esophageal Adenocarcinoma. Clin Gastroenterol Hepatol. 2018;16(8):1229-1236.e4. doi:10.1016/j.cgh.2018.03.014
  6. Rubenstein JH, Evans RR, Burns JA, et al. Patients With Adenocarcinoma of the Esophagus or Esophagogastric Junction Frequently Have Potential Screening Opportunities. Gastroenterology. 2022;162(4):1349-1351.e5. doi:10.1053/j.gastro.2021.12.255
  7. Xie S-H, Ness-Jensen E, Medefelt N, Lagergren J. Assessing the feasibility of targeted screening for esophageal adenocarcinoma based on individual risk assessment in a population-based cohort study in Norway (The HUNT Study). Am J Gastroenterol. 2018;113(6):829-835. doi:10.1038/s41395-018-0069-9
  8. Rubenstein JH, Fontaine S, MacDonald PW, et al. Predicting Incident Adenocarcinoma of the Esophagus or Gastric Cardia Using Machine Learning of Electronic Health Records. Gastroenterology. 2023;165(6):1420-1429.e10. doi:10.1053/j.gastro.2023.08.011
  9. Fitzgerald RC, di Pietro M, O’Donovan M, et al. Cytosponge-trefoil factor 3 versus usual care to identify Barrett’s oesophagus in a primary care setting: a multicentre, pragmatic, randomised controlled trial. Lancet. 2020;396(10247):333-344. doi:10.1016/S0140-6736(20)31099-0
  10. Moinova HR, Verma S, Dumot J, et al. Multicenter, Prospective Trial of Nonendoscopic
    Biomarker-Driven Detection of Barrett’s Esophagus and Esophageal Adenocarcinoma. Am J Gastroenterol. 2024;119(11):2206-2214. doi:10.14309/ajg.0000000000002850
  11. Shaheen NJ, Falk GW, Iyer PG, et al. Diagnosis and Management of Barrett’s Esophagus: An Updated ACG Guideline. Am J Gastroenterol. 2022;117(4):559-587. doi:10.14309/ajg.0000000000001680
  12. ASGE STANDARDS OF PRACTICE COMMITTEE; Qumseya B, Sultan S, Bain P, et al. ASGE guideline on screening and surveillance of Barrett’s esophagus. Gastrointest Endosc. 2019;90(3):335-359.e2. doi:10.1016/j.gie.2019.05.012
  13. Muthusamy VR, Wani S, Gyawali CP, Komanduri S. CGIT Barrett’s Esophagus Consensus Conference Participants. AGA Clinical Practice Update on New Technology and Innovation for Surveillance and Screening in Barrett’s Esophagus: Expert review. Clin Gastroenterol Hepatol. 2022;20(12):2696-2706. doi:10.1016/j.cgh.2022.06.003
  14. Xie SH, Lagergren J. A model for predicting individuals’ absolute risk of esophageal adenocarcinoma: Moving toward tailored screening and prevention. Int J Cancer. 2016;138(12):2813-2819. doi:10.1002/ijc.29988
  15. Rubenstein JH, McConnell D, Waljee AK, et al. Validation and Comparison of Tools for Selecting Individuals to Screen for Barrett’s Esophagus and Early Neoplasia. Gastroenterology. 2020;158(8):2082-2092. doi:10.1053/j.gastro.2020.02.037
  16. Iyer PG, Sachdeva K, Leggett CL, et al. Development of Electronic Health Record–Based Machine Learning Models to Predict Barrett’s Esophagus and Esophageal Adenocarcinoma Risk. Clin Transl Gastroenterol. 2023;14(10):e00637. doi:10.14309/ctg.0000000000000637
  17. Ross-Innes CS, Debiram-Beecham I, O’Donovan M, et al; BEST2 Study Group. Evaluation of a minimally invasive cell sampling device coupled with assessment of trefoil factor 3 expression for diagnosing Barrett’s esophagus: a multicenter case-control study. PLoS Med. 2015;12(1):e1001780. doi:10.1371/journal.pmed.1001780
Author and Disclosure Information

Joel Rubenstein, MD, MS
Professor, Department of Internal Medicine,
Division of Gastroenterology, University of
Michigan Medical School Director, Barrett's
Esophagus Program, Michigan Medicine,
Ann Arbor, Michigan
Disclosures: Received research grant from: Lucid Diagnostics

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GI and Hepatology News
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Gastrointestinal Cancer
Author(s)
Joel Rubenstein, MD, MS
Author(s)
Joel Rubenstein, MD, MS
Author and Disclosure Information

Joel Rubenstein, MD, MS
Professor, Department of Internal Medicine,
Division of Gastroenterology, University of
Michigan Medical School Director, Barrett's
Esophagus Program, Michigan Medicine,
Ann Arbor, Michigan
Disclosures: Received research grant from: Lucid Diagnostics

Author and Disclosure Information

Joel Rubenstein, MD, MS
Professor, Department of Internal Medicine,
Division of Gastroenterology, University of
Michigan Medical School Director, Barrett's
Esophagus Program, Michigan Medicine,
Ann Arbor, Michigan
Disclosures: Received research grant from: Lucid Diagnostics

Click to view more from Gastroenterology Data Trends 2025.

Click to view more from Gastroenterology Data Trends 2025.

References
  1. Vantanasiri K, Kamboj AK, Kisiel JB, Iyer PG. Advances in Screening for Barrett Esophagus and Esophageal Adenocarcinoma. Mayo Clin Proc. 2024;99(3):459-473. doi:10.1016/j.mayocp.2023.07.014
  2. Cancer Stat Facts: Esophageal Cancer. NIH National Cancer Institute: Survival, Epidemiology, and End Results Program web site. Accessed March 12, 2025. https://seer.cancer.gov/statfacts/html/esoph.html
  3. Seer*Explorer: Esophagus. NIH National Cancer Institute: Survival, Epidemiology, and End Results Program web site. Accessed March 4, 2025. https://seer.cancer.gov/statistics-network/explorer/application.html
  4. Kolb JM, Chen M, Tavakkoli A, et al. Understanding Compliance, Practice Patterns, and Barriers Among Gastroenterologists and Primary Care Providers Is Crucial for Developing Strategies to Improve Screening for Barrett’s Esophagus. Gastroenterology. 2022;162(6):1568-1573.e4. doi:10.1053/j.gastro.2022.02.003
  5. Kunzmann AT, Thrift AP, Cardwell CR, et al. Model for Identifying Individuals at Risk for Esophageal Adenocarcinoma. Clin Gastroenterol Hepatol. 2018;16(8):1229-1236.e4. doi:10.1016/j.cgh.2018.03.014
  6. Rubenstein JH, Evans RR, Burns JA, et al. Patients With Adenocarcinoma of the Esophagus or Esophagogastric Junction Frequently Have Potential Screening Opportunities. Gastroenterology. 2022;162(4):1349-1351.e5. doi:10.1053/j.gastro.2021.12.255
  7. Xie S-H, Ness-Jensen E, Medefelt N, Lagergren J. Assessing the feasibility of targeted screening for esophageal adenocarcinoma based on individual risk assessment in a population-based cohort study in Norway (The HUNT Study). Am J Gastroenterol. 2018;113(6):829-835. doi:10.1038/s41395-018-0069-9
  8. Rubenstein JH, Fontaine S, MacDonald PW, et al. Predicting Incident Adenocarcinoma of the Esophagus or Gastric Cardia Using Machine Learning of Electronic Health Records. Gastroenterology. 2023;165(6):1420-1429.e10. doi:10.1053/j.gastro.2023.08.011
  9. Fitzgerald RC, di Pietro M, O’Donovan M, et al. Cytosponge-trefoil factor 3 versus usual care to identify Barrett’s oesophagus in a primary care setting: a multicentre, pragmatic, randomised controlled trial. Lancet. 2020;396(10247):333-344. doi:10.1016/S0140-6736(20)31099-0
  10. Moinova HR, Verma S, Dumot J, et al. Multicenter, Prospective Trial of Nonendoscopic
    Biomarker-Driven Detection of Barrett’s Esophagus and Esophageal Adenocarcinoma. Am J Gastroenterol. 2024;119(11):2206-2214. doi:10.14309/ajg.0000000000002850
  11. Shaheen NJ, Falk GW, Iyer PG, et al. Diagnosis and Management of Barrett’s Esophagus: An Updated ACG Guideline. Am J Gastroenterol. 2022;117(4):559-587. doi:10.14309/ajg.0000000000001680
  12. ASGE STANDARDS OF PRACTICE COMMITTEE; Qumseya B, Sultan S, Bain P, et al. ASGE guideline on screening and surveillance of Barrett’s esophagus. Gastrointest Endosc. 2019;90(3):335-359.e2. doi:10.1016/j.gie.2019.05.012
  13. Muthusamy VR, Wani S, Gyawali CP, Komanduri S. CGIT Barrett’s Esophagus Consensus Conference Participants. AGA Clinical Practice Update on New Technology and Innovation for Surveillance and Screening in Barrett’s Esophagus: Expert review. Clin Gastroenterol Hepatol. 2022;20(12):2696-2706. doi:10.1016/j.cgh.2022.06.003
  14. Xie SH, Lagergren J. A model for predicting individuals’ absolute risk of esophageal adenocarcinoma: Moving toward tailored screening and prevention. Int J Cancer. 2016;138(12):2813-2819. doi:10.1002/ijc.29988
  15. Rubenstein JH, McConnell D, Waljee AK, et al. Validation and Comparison of Tools for Selecting Individuals to Screen for Barrett’s Esophagus and Early Neoplasia. Gastroenterology. 2020;158(8):2082-2092. doi:10.1053/j.gastro.2020.02.037
  16. Iyer PG, Sachdeva K, Leggett CL, et al. Development of Electronic Health Record–Based Machine Learning Models to Predict Barrett’s Esophagus and Esophageal Adenocarcinoma Risk. Clin Transl Gastroenterol. 2023;14(10):e00637. doi:10.14309/ctg.0000000000000637
  17. Ross-Innes CS, Debiram-Beecham I, O’Donovan M, et al; BEST2 Study Group. Evaluation of a minimally invasive cell sampling device coupled with assessment of trefoil factor 3 expression for diagnosing Barrett’s esophagus: a multicenter case-control study. PLoS Med. 2015;12(1):e1001780. doi:10.1371/journal.pmed.1001780
References
  1. Vantanasiri K, Kamboj AK, Kisiel JB, Iyer PG. Advances in Screening for Barrett Esophagus and Esophageal Adenocarcinoma. Mayo Clin Proc. 2024;99(3):459-473. doi:10.1016/j.mayocp.2023.07.014
  2. Cancer Stat Facts: Esophageal Cancer. NIH National Cancer Institute: Survival, Epidemiology, and End Results Program web site. Accessed March 12, 2025. https://seer.cancer.gov/statfacts/html/esoph.html
  3. Seer*Explorer: Esophagus. NIH National Cancer Institute: Survival, Epidemiology, and End Results Program web site. Accessed March 4, 2025. https://seer.cancer.gov/statistics-network/explorer/application.html
  4. Kolb JM, Chen M, Tavakkoli A, et al. Understanding Compliance, Practice Patterns, and Barriers Among Gastroenterologists and Primary Care Providers Is Crucial for Developing Strategies to Improve Screening for Barrett’s Esophagus. Gastroenterology. 2022;162(6):1568-1573.e4. doi:10.1053/j.gastro.2022.02.003
  5. Kunzmann AT, Thrift AP, Cardwell CR, et al. Model for Identifying Individuals at Risk for Esophageal Adenocarcinoma. Clin Gastroenterol Hepatol. 2018;16(8):1229-1236.e4. doi:10.1016/j.cgh.2018.03.014
  6. Rubenstein JH, Evans RR, Burns JA, et al. Patients With Adenocarcinoma of the Esophagus or Esophagogastric Junction Frequently Have Potential Screening Opportunities. Gastroenterology. 2022;162(4):1349-1351.e5. doi:10.1053/j.gastro.2021.12.255
  7. Xie S-H, Ness-Jensen E, Medefelt N, Lagergren J. Assessing the feasibility of targeted screening for esophageal adenocarcinoma based on individual risk assessment in a population-based cohort study in Norway (The HUNT Study). Am J Gastroenterol. 2018;113(6):829-835. doi:10.1038/s41395-018-0069-9
  8. Rubenstein JH, Fontaine S, MacDonald PW, et al. Predicting Incident Adenocarcinoma of the Esophagus or Gastric Cardia Using Machine Learning of Electronic Health Records. Gastroenterology. 2023;165(6):1420-1429.e10. doi:10.1053/j.gastro.2023.08.011
  9. Fitzgerald RC, di Pietro M, O’Donovan M, et al. Cytosponge-trefoil factor 3 versus usual care to identify Barrett’s oesophagus in a primary care setting: a multicentre, pragmatic, randomised controlled trial. Lancet. 2020;396(10247):333-344. doi:10.1016/S0140-6736(20)31099-0
  10. Moinova HR, Verma S, Dumot J, et al. Multicenter, Prospective Trial of Nonendoscopic
    Biomarker-Driven Detection of Barrett’s Esophagus and Esophageal Adenocarcinoma. Am J Gastroenterol. 2024;119(11):2206-2214. doi:10.14309/ajg.0000000000002850
  11. Shaheen NJ, Falk GW, Iyer PG, et al. Diagnosis and Management of Barrett’s Esophagus: An Updated ACG Guideline. Am J Gastroenterol. 2022;117(4):559-587. doi:10.14309/ajg.0000000000001680
  12. ASGE STANDARDS OF PRACTICE COMMITTEE; Qumseya B, Sultan S, Bain P, et al. ASGE guideline on screening and surveillance of Barrett’s esophagus. Gastrointest Endosc. 2019;90(3):335-359.e2. doi:10.1016/j.gie.2019.05.012
  13. Muthusamy VR, Wani S, Gyawali CP, Komanduri S. CGIT Barrett’s Esophagus Consensus Conference Participants. AGA Clinical Practice Update on New Technology and Innovation for Surveillance and Screening in Barrett’s Esophagus: Expert review. Clin Gastroenterol Hepatol. 2022;20(12):2696-2706. doi:10.1016/j.cgh.2022.06.003
  14. Xie SH, Lagergren J. A model for predicting individuals’ absolute risk of esophageal adenocarcinoma: Moving toward tailored screening and prevention. Int J Cancer. 2016;138(12):2813-2819. doi:10.1002/ijc.29988
  15. Rubenstein JH, McConnell D, Waljee AK, et al. Validation and Comparison of Tools for Selecting Individuals to Screen for Barrett’s Esophagus and Early Neoplasia. Gastroenterology. 2020;158(8):2082-2092. doi:10.1053/j.gastro.2020.02.037
  16. Iyer PG, Sachdeva K, Leggett CL, et al. Development of Electronic Health Record–Based Machine Learning Models to Predict Barrett’s Esophagus and Esophageal Adenocarcinoma Risk. Clin Transl Gastroenterol. 2023;14(10):e00637. doi:10.14309/ctg.0000000000000637
  17. Ross-Innes CS, Debiram-Beecham I, O’Donovan M, et al; BEST2 Study Group. Evaluation of a minimally invasive cell sampling device coupled with assessment of trefoil factor 3 expression for diagnosing Barrett’s esophagus: a multicenter case-control study. PLoS Med. 2015;12(1):e1001780. doi:10.1371/journal.pmed.1001780
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Advances in Screening for Barrett’s Esophagus and Esophageal Adenocarcinoma

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Barrett’s esophagus (BE) is a metaplastic transformation of the esophageal lining and the sole known precursor to esophageal adenocarcinoma (EAC), a malignancy with a 20% 5-year survival rate and about 16,000 new cases per year.1-3 Despite a lack of high-quality evidence supporting screening, guidelines suggest screening and focus heavily on endoscopy for individuals with gastroesophageal reflux disease (GERD) and other risk factors.1 Barriers to screening include reliance on GERD symptoms (given only 50% of individuals with EAC report prior GERD symptoms), provider lack of knowledge about guidelines, and the invasive nature of endoscopy.4,5 Fewer than 20% of EAC cases are detected as part of screening and surveillance.6 As many as 85% of individuals with EAC also had at least 1 missed opportunity where screening endoscopy could have been offered earlier.6

Predictive algorithms incorporating factors like age, GERD, obesity, and smoking history (e.g., Nord-Trøndelag Health Study [HUNT], Kunzmann, Kettles Esophageal and Cardia Adenocarcinoma predictioN [K-ECAN] tools) have been developed to better identify at-risk populations who should undergo screening.5,7,8 New screening modalities are also being developed. Non-endoscopic tools, such as EsoCheck with EsoGuard and Cytosponge, offer minimally invasive alternatives for detecting BE.9,10 Future efforts should focus on enhancing risk stratification, improving the referral process to screen appropriate populations, and integrating new technologies to enable earlier diagnosis and intervention, potentially improving survival outcomes for EAC.

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