TY - JOUR
T1 - Surveillance in Barrett's Esophagus
T2 - Challenges, Progress, and Possibilities
AU - Iyer, Prasad G.
AU - Chak, Amitabh
N1 - Publisher Copyright:
© 2023 AGA Institute
PY - 2023/4
Y1 - 2023/4
N2 - Endoscopic surveillance of Barrett's esophagus, aiming to detect prevalent dysplasia and adenocarcinoma, followed by effective endoscopic treatment, is an integral part of the esophageal adenocarcinoma prevention paradigm. However, several limitations, such as the subtle appearance of dysplasia, sampling error (inherent in current surveillance protocols), and noncompliance with surveillance recommendations, lead to missed dysplasia and neoplasia, reducing the effectiveness of surveillance as currently practiced. Careful endoscopic assessment with high-resolution white-light endoscopy, dye-based or electronic chromoendoscopy, and comprehensive sampling of the BE mucosa, remains the cornerstone of endoscopic surveillance. Emerging innovations in this area span the gamut of more efficient sampling methods, advanced imaging tools, artificial intelligence, and molecular marker–powered approaches as adjuncts, to identify prevalent and predict incident dysplasia or adenocarcinoma. Development and implementation of validated quality indicators will allow additional advancement of this critical field. These approaches will hopefully enable efficient and effective cancer prevention and treatment.
AB - Endoscopic surveillance of Barrett's esophagus, aiming to detect prevalent dysplasia and adenocarcinoma, followed by effective endoscopic treatment, is an integral part of the esophageal adenocarcinoma prevention paradigm. However, several limitations, such as the subtle appearance of dysplasia, sampling error (inherent in current surveillance protocols), and noncompliance with surveillance recommendations, lead to missed dysplasia and neoplasia, reducing the effectiveness of surveillance as currently practiced. Careful endoscopic assessment with high-resolution white-light endoscopy, dye-based or electronic chromoendoscopy, and comprehensive sampling of the BE mucosa, remains the cornerstone of endoscopic surveillance. Emerging innovations in this area span the gamut of more efficient sampling methods, advanced imaging tools, artificial intelligence, and molecular marker–powered approaches as adjuncts, to identify prevalent and predict incident dysplasia or adenocarcinoma. Development and implementation of validated quality indicators will allow additional advancement of this critical field. These approaches will hopefully enable efficient and effective cancer prevention and treatment.
KW - Adenocarcinoma
KW - Cancer Prevention
KW - Dysplasia
KW - Effectiveness
KW - Surveillance
UR - http://www.scopus.com/inward/record.url?scp=85150257452&partnerID=8YFLogxK
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U2 - 10.1053/j.gastro.2023.01.031
DO - 10.1053/j.gastro.2023.01.031
M3 - Article
C2 - 36746210
AN - SCOPUS:85150257452
SN - 0016-5085
VL - 164
SP - 707
EP - 718
JO - Gastroenterology
JF - Gastroenterology
IS - 5
ER -