Detection and surveillance of neoplastic lesions of the esophagus: application of guidelines and techniques

Esophageal cancer is the eighth most common cancer in the world, with high mortality rates. The two main histological subtypes of esophageal cancer are esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC). Both EAC/ESCC are generally preceded by a stepwise progression of precursor metaplastic [Barrett’s esophagus (BE)] and dysplastic lesions, which increase the risk of developing cancer by several folds. Despite advances in management techniques, esophageal cancer continues to have a grim prognosis because it is often detected after the emergence of alarm symptoms. This highlights the need for intensive screening and surveillance with an aim to detect precursor lesions and early-stage esophageal cancer. Multiple international society guidelines recommend screening high-risk populations for BE/EAC, but ESCC screening is not widely recommended. Endoscopic screening remains the gold standard but is not feasible for large-scale application due to associated cost, invasiveness, and required expertise. Ongoing innovations in developing minimally invasive non-endoscopic screening tools combined with molecular biomarkers have fueled further interest in screening and surveillance of high-risk populations. Advanced endoscopic imaging techniques help enhance the surveillance-based detection of precursor lesions, guide targeted tissue acquisition, and stratify the risk of progression to advanced dysplasia/ cancer. Multimodal endoscopic eradication therapies have been shown to eradicate dysplasia and reduce progression to EAC/ESCC with minimal adverse effects. Future implementation of minimally invasive screening tools, identification of the prognostic clinical and biomarker tools and adherence to the quality metrics for BE detection will potentially result in significant improvement in the mortality and morbidity related to esophageal cancer.