To BE or not to BE: non-invasive screening for Barrett’s esophagus, dysplasia and adenocarcinoma

The EsophaCap？ DNA methylation biomarker validation study by Wang, Kambhampati and colleagues (1) follows a spade of reports (summarized in Table 1) aiming to develop screening tests for Barrett’s esophagus (BE). BE is a non-malignant metaplastic condition with little or no clinical symptoms. Arguably, the main importance of diagnosing BE is the increased risk of the patient to progress to esophageal adenocarcinoma (EAC). EAC has surpassed esophageal squamous cell carcinoma as the most common histological type of esophageal cancer in Western countries and its incidence is predicted to grow, possibly associated with life style and obesity (6,7). The majority of EAC are diagnosed at late stages, when it is associated with poor survival (6). Early detection and eradication at dysplasia stages is associated with improved survival (8). To detect early dysplastic changes, BE patients routinely undergo endoscopic surveillance, but endoscopic screening is currently recommended only for patients with multiple risk factors (Figure 1), due to the invasive nature the procedure (9,10)