Q&A: non-endoscopic detection for BE, esophageal adenocarcinoma
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Progress in the non-endoscopic detection for Barrett’s esophagus may lead to increased identification of those at risk for esophageal adenocarcinoma, according to opinions published in Annals of Internal Medicine.
The American Cancer Society reports that esophageal adenocarcinoma (EAC) is a lethal form of cancer estimated to result in 15,530 deaths this year. While endoscopic screening followed by treatment for dysplasia can reduce the risk for BE progression to EAC, 90% of patients with EAC continue to be diagnosed outside of screening despite the presence of BE in 60% of EACs at diagnosis.
Improved surveillance, with inclusion of a wider range of indicative symptoms, is essential in earlier stage detection and may lead to meaningful advances in EAC outcomes; minimally invasive non-endoscopic esophageal sampling devices combined with molecular markers to detect BE and early-stage EAC are currently in development and undergoing case-control studies.
Prasad G. Iyer, MD, MS, FACG, FASGE, Mayo Clinic Center for Clinical and Translational Science, spoke with Healio Gastroenterology about the importance of exploring non-endoscopic detection for BE and early-stage EAC and his hope for its future implications on EAC outcomes.
Healio: What was the impetus for exploring minimally invasive non-endoscopic detection of BE and EAC?
Iyer: The impetus is the rapidly rising incidence of EAC and the unsuitability of the endoscopy to be used as a widely applicable tool to detect the precursor lesion for EAC: BE.
Healio: What implications might this have on early detection moving forward?
Iyer: We hope that these non-endoscopic tools allow more widespread application of screening for BE, leading to greater detection of dysplasia — which can be treated endoscopically to prevent EAC — and early-stage EAC, which also can be treated successfully endoscopically with good long-term outcomes.
Healio: What implications might this have for future preventive strategies or EAC outcomes?
Iyer: Given their low cost, safety and tolerability, these tools can be implemented in a wider population without the need for gastroesophageal reflux disease as an essential risk factor, allowing for the detection of a higher proportion of prevalent BE and improvement in EAC prevention.
Healio: What is the most important take-home message regarding advancements in non-endoscopic detection and what is the next step in future research?
Iyer: These tools may allow wider access, hopefully greater participation and detection of a majority of prevalent BE. This makes EAC prevention more likely. The next step in future research is identification of the best population to implement non-endoscopic BE detection.
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