Shaheen Nicholas, Iyer Prasad, Eluri Swathi
Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona.
Gastroenterol Hepatol (N Y). 2025 Jun;21(6):353-361.
Current screening methods for Barrett esophagus (BE), the precursor to esophageal adenocarcinoma (EAC), are inadequate with less than one-third of screen-eligible patients currently undergoing screening. In addition to low screening rates, key issues include overemphasis on gastroesophageal reflux disease symptoms and lack of provider awareness, owing in part to heterogeneous guidelines. To address these challenges, several new approaches are being explored: swallowable cell collection devices, exhaled volatile organic compounds analysis, blood-based molecular biomarkers, microbiome analysis, and alternative visualization methods such as transnasal and capsule endos-copy. Proposed strategies to improve BE screening integrate enhanced risk stratification tools using machine learning and electronic health record data, noninvasive screening for low-risk patients, traditional endoscopy for high-risk patients, primary care education, and public health initiatives to increase awareness. This article highlights the latest developments in BE detection, including noninvasive screening methods and strategies to improve risk stratification, that have the potential to reduce EAC incidence and mortality.
巴雷特食管（BE）是食管腺癌（EAC）的癌前病变，目前针对BE的筛查方法并不完善，目前接受筛查的符合筛查条件的患者不到三分之一。除了筛查率低之外，关键问题还包括过度强调胃食管反流病症状以及医疗服务提供者缺乏认识，部分原因是指南存在差异。为应对这些挑战，人们正在探索几种新方法：可吞咽细胞采集装置、呼出挥发性有机化合物分析、基于血液的分子生物标志物、微生物组分析以及经鼻和胶囊内镜等替代可视化方法。为改善BE筛查而提出的策略包括利用机器学习和电子健康记录数据的强化风险分层工具、对低风险患者进行非侵入性筛查、对高风险患者进行传统内镜检查、初级保健教育以及提高认识的公共卫生举措。本文重点介绍了BE检测的最新进展，包括非侵入性筛查方法和改善风险分层的策略，这些进展有可能降低EAC的发病率和死亡率。
