ASGE Esophagology: Tailoring Management from Testing to Treatment (Live and Virtual) | July 2022-Iyer - Risk Stratification of Screening and surveillance in BE 7-15

Iyer - Risk Stratification of Screening and surveillance in BE 7-15

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This document discusses the risk stratification of screening and surveillance in Barrett's esophagus (BE). It covers current recommendations for BE screening, including the identification of risk factors such as age, gender, race, obesity, smoking, and family history. The document highlights the use of endoscopy and non-endoscopic methods, such as swallowable esophageal cell collection devices and biomarker tests, for screening. Various BE and esophageal adenocarcinoma (EAC) risk assessment tools are also discussed, which take into account factors such as age, GERD, smoking, and BMI.<br /><br />In terms of surveillance, the document provides recommendations for monitoring BE progression based on factors like demographics, lifestyle (smoking, alcohol, BMI), BE characteristics (dysplasia status, length), and medication use (NSAIDs, statins, PPIs). Clinical progression scores are mentioned, along with the use of biomarkers to predict progression. Specific biomarkers discussed include p53, abnormal DNA ploidy, and molecular progression panels.<br /><br />The document highlights the challenges in developing and implementing prediction biomarkers, such as the need for prospective validation, specialized sample types, and analysis platforms, as well as the importance of commercial partnerships and reimbursement. In summary, risk assessment plays a critical role in BE screening, and surveillance should be personalized based on factors such as BE length and dysplasia grade. Various tools, including clinical scores, biomarkers, and AI-based models, are being developed to aid in risk stratification, although challenges remain in their implementation.

Keywords

risk stratification

screening

surveillance

Barrett's esophagus

risk factors

endoscopy

biomarker tests

esophageal adenocarcinoma

EAC